Healthcare Provider Details

I. General information

NPI: 1740275841
Provider Name (Legal Business Name): JANE ALLISON BAILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/21/2022
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2505
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-44203
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21427
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65267
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number65267
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: