Healthcare Provider Details

I. General information

NPI: 1386878080
Provider Name (Legal Business Name): MATTHEW BRUCE BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY LCSB - 2
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

1221 S BROADWAY LCSB - 2
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4271
  • Fax: 859-258-4296
Mailing address:
  • Phone: 859-258-4271
  • Fax: 859-258-4296

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 State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number47015
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: