Healthcare Provider Details

I. General information

NPI: 1306137708
Provider Name (Legal Business Name): GEOFFREY STUART BAILEY-GATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CLAY ST SUITE 380
SAN FRANCISCO CA
94115-1931
US

IV. Provider business mailing address

2351 CLAY ST SUITE 380
SAN FRANCISCO CA
94115-1931
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3954
  • Fax:
Mailing address:
  • Phone: 415-600-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTJ818352
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: