Healthcare Provider Details

I. General information

NPI: 1992870380
Provider Name (Legal Business Name): JOHN ANTHONY BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 NW 8TH AVE STE 2
GAINESVILLE FL
32605-4582
US

IV. Provider business mailing address

4343 W NEWBERRY RD STE 6
GAINESVILLE FL
32607-2817
US

V. Phone/Fax

Practice location:
  • Phone: 352-547-2373
  • Fax: 352-291-0231
Mailing address:
  • Phone: 352-547-2373
  • Fax: 352-291-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME 95069
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberME 95069
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number15078
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15078
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: