Healthcare Provider Details

I. General information

NPI: 1487642393
Provider Name (Legal Business Name): MICHAEL GENE BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 COLLEGE AVE
LEVELLAND TX
79336-6507
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-3141
  • Fax:
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH4146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: