Healthcare Provider Details

I. General information

NPI: 1508801754
Provider Name (Legal Business Name): RICHARD W BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1604
US

IV. Provider business mailing address

686 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1604
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-5052
  • Fax: 606-549-2718
Mailing address:
  • Phone: 606-549-5052
  • Fax: 606-549-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38418
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: