MEDICARE: JIMMIE DALE BAILEY II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD. 22758	AL
2	207Q00000X	Family Medicine Physician	DR.0065419	CO
3	207Q00000X	Family Medicine Physician	ME 125949	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR.0065419	OTHER	CO	CO LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235126582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMIE DALE BAILEY II MD

Provider Business Mailing Address
First Line	:	1001 E JOHNSON ST
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2500
Fax Number	:	970-854-3887

Provider Business Practice Location Address
First Line	:	1001 E JOHNSON ST
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2500
Fax Number	:	970-854-3887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	06/27/2022

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