Healthcare Provider Details

I. General information

NPI: 1407875008
Provider Name (Legal Business Name): ROBIN KEITH BAILEY PA-C, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: R KEITH BAILEY PA-C, MD

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 TRAPPERS RIDGE DR
ROCKWELL NC
28138-8573
US

IV. Provider business mailing address

318 TRAPPERS RIDGE DR
ROCKWELL NC
28138-8573
US

V. Phone/Fax

Practice location:
  • Phone: 727-433-2179
  • Fax:
Mailing address:
  • Phone: 727-433-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2145
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number101393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: