Healthcare Provider Details

I. General information

NPI: 1063415354
Provider Name (Legal Business Name): JOHN DEE BAILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N ELSON ST
KIRKSVILLE MO
63501-1141
US

IV. Provider business mailing address

21469 LAKE WOOD TRL
KIRKSVILLE MO
63501-7675
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-0950
  • Fax: 660-665-0699
Mailing address:
  • Phone: 660-627-0989
  • Fax: 660-627-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMO110360
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: