Healthcare Provider Details

I. General information

NPI: 1710988696
Provider Name (Legal Business Name): DANIEL JAMES BAILLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 MISSION ST SE
SALEM OR
97302-6222
US

IV. Provider business mailing address

885 MISSION ST SE
SALEM OR
97302-6222
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-5585
  • Fax: 503-587-7823
Mailing address:
  • Phone: 503-585-5585
  • Fax: 503-587-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD12677
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: