=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487631099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID S BAILIE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2005
-----------------------------------------------------
Last Update Date | 12/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20401 N 73RD ST STE 155
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-264-6995
-----------------------------------------------------
Fax | 844-574-8199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9375 E SHEA BLVD STE 263
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-264-6995
-----------------------------------------------------
Fax | 844-574-8199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 23831
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------