Healthcare Provider Details

I. General information

NPI: 1346288123
Provider Name (Legal Business Name): ROBERT B BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 NW DIVISION ST
GRESHAM OR
97030-5506
US

IV. Provider business mailing address

PO BOX 13994
PORTLAND OR
97213-0994
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9500
  • Fax: 503-215-9525
Mailing address:
  • Phone: 503-215-6494
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14712
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: