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General NPI Number Information
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NPI Number | 1316005143
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Entity Type | Individual
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Provider Name | RONALD WESLEY BAILEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | MOUNTAIN HOME AFB MEDICAL GROUP 90 HOPE DRIVE, BUILDING 6000
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City | MOUNTAIN HOME AFB
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State | ID
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Zip | 83648
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Country | US
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Telephone | 208-828-7815
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Fax |
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Provider Business Mailing Address
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Address Line | 708 MICHAELS CRK
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City | EVANS
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State | GA
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Zip | 30809-4042
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Country | US
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Telephone | 706-868-0972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 66563
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2000-00713
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 66563
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License Number State | GA
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