Healthcare Provider Details

I. General information

NPI: 1144584905
Provider Name (Legal Business Name): JAMES ROBERT BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST # M200
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

151 S EAST ST APT 111
INDIANAPOLIS IN
46202-4074
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-4756
  • Fax:
Mailing address:
  • Phone: 317-656-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11016645A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: