Healthcare Provider Details

I. General information

NPI: 1871595413
Provider Name (Legal Business Name): JOHN D BAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 CENTENNIAL HILLS BLVD SUITE A
CASPER WY
82609-3265
US

IV. Provider business mailing address

4140 CENTENNIAL HILLS BLVD SUITE A
CASPER WY
82609-3265
US

V. Phone/Fax

Practice location:
  • Phone: 307-265-7205
  • Fax: 307-235-6262
Mailing address:
  • Phone: 307-265-7205
  • Fax: 307-235-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2761A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: