Healthcare Provider Details

I. General information

NPI: 1952834046
Provider Name (Legal Business Name): BAILEY LYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/31/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

882A CALLE TORREADOR
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3361
  • Fax:
Mailing address:
  • Phone: 404-277-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberNOT AVAILABLE
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2020-0257
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: