Healthcare Provider Details

I. General information

NPI: 1396912911
Provider Name (Legal Business Name): SAMUEL STEVEN BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 N SCOTTSDALE HEALTHCARE DR STE 230
SCOTTSDALE AZ
85255-4134
US

IV. Provider business mailing address

20201 N SCOTTSDALE HEALTHCARE DR STE 230
SCOTTSDALE AZ
85255-4134
US

V. Phone/Fax

Practice location:
  • Phone: 480-684-1360
  • Fax: 480-273-8695
Mailing address:
  • Phone: 480-684-1360
  • Fax: 480-273-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number41765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: