Healthcare Provider Details

I. General information

NPI: 1619943255
Provider Name (Legal Business Name): JAMES KEITH BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FLYNN DR
MILBANK SD
57252-1508
US

IV. Provider business mailing address

301 FLYNN DR
MILBANK SD
57252-1508
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-4587
  • Fax: 605-432-4580
Mailing address:
  • Phone: 605-432-4587
  • Fax: 605-432-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10765
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: