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General NPI Number Information
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NPI Number | 1235324435
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Entity Type | Organization
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Legal Business Name | GREGORY N BAILEY PAC INC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 6175 NW 153RD ST SUITE 301
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2435
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Country | US
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Telephone | 305-558-9522
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Fax | 305-558-9520
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Provider Business Mailing Address
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Address Line | 6175 NW 153RD ST SUITE 301
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2435
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Country | US
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Telephone | 305-558-9522
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Fax | 305-558-9520
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY N BAILEY
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Credential | P.A.
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Telephone | 305-558-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9101559
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License Number State | FL
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