Healthcare Provider Details

I. General information

NPI: 1437145174
Provider Name (Legal Business Name): CHARLES EDWARD BAILEY MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST. BUILDING 1 SUITE A
AUSTIN TX
78745
US

IV. Provider business mailing address

4310 JAMES CASEY ST BUILDING 1 SUITE A
AUSTIN TX
78745
US

V. Phone/Fax

Practice location:
  • Phone: 512-504-7411
  • Fax: 512-215-8824
Mailing address:
  • Phone: 512-504-7411
  • Fax: 512-215-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM1485
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM1485
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: