Healthcare Provider Details

I. General information

NPI: 1942492426
Provider Name (Legal Business Name): ZACHARY MAX BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORD RD
JOHN DAY OR
97845-1088
US

IV. Provider business mailing address

180 FORD RD
JOHN DAY OR
97845-1088
US

V. Phone/Fax

Practice location:
  • Phone: 541-575-0404
  • Fax: 541-575-1124
Mailing address:
  • Phone: 541-575-0404
  • Fax: 541-575-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5010711205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29025
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: