Healthcare Provider Details

I. General information

NPI: 1063858553
Provider Name (Legal Business Name): PHILLIP GABRIEL BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2013
Last Update Date: 12/14/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI ST STE 200
DUBUQUE IA
52001-6320
US

IV. Provider business mailing address

1515 DELHI ST STE 200
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-7000
  • Fax:
Mailing address:
  • Phone: 563-557-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036156827
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-46240
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: