Healthcare Provider Details

I. General information

NPI: 1053395392
Provider Name (Legal Business Name): WILLIAM M BAILEY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 VILLA RD STE 114
NEWBERG OR
97132-1881
US

IV. Provider business mailing address

308 VILLA RD STE 114
NEWBERG OR
97132-1881
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-9431
  • Fax: 503-538-2358
Mailing address:
  • Phone: 503-538-9431
  • Fax: 503-538-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14622
License Number StateOR

VIII. Authorized Official

Name: DR. WILLIAM MERRILL BAILEY
Title or Position: OWNER
Credential: MD
Phone: 503-538-9431