Healthcare Provider Details

I. General information

NPI: 1265430656
Provider Name (Legal Business Name): BRIAN D BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY BLDG 12
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3150
  • Fax: 337-470-3161
Mailing address:
  • Phone: 337-470-3150
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15468R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: