Healthcare Provider Details

I. General information

NPI: 1679761704
Provider Name (Legal Business Name): RICHARD BAILEY, M.D., L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 HWY 95 SUITE 101
BULLHEAD CITY AZ
86442-6050
US

IV. Provider business mailing address

PO BOX 21944
BULLHEAD CITY AZ
86439-1944
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-1020
  • Fax: 728-763-2076
Mailing address:
  • Phone: 928-763-1020
  • Fax: 928-763-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD L BAILEY
Title or Position: OWNER
Credential: M.D.
Phone: 928-763-1020