Healthcare Provider Details

I. General information

NPI: 1487180238
Provider Name (Legal Business Name): RYAN SCOTT BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/22/2023
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-2422
  • Fax:
Mailing address:
  • Phone: 320-252-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTBD
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberR-12657
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number73099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: