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General NPI Number Information
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NPI Number | 1366422008
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Entity Type | Individual
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Provider Name | MITCHELL EDWARD BAILEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 30 MARK WEST SPRINGS RD
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City | SANTA ROSA
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State | CA
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Zip | 95403-1436
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Country | US
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Telephone | 707-328-9673
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Fax |
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Provider Business Mailing Address
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Address Line | 9030 W SAHARA AVE # 118
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City | LAS VEGAS
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State | NV
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Zip | 89117-5744
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Country | US
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Telephone | 702-453-3799
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Fax | 702-453-5741
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G25349
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License Number State | CA
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