MEDICARE: DR. MARK S BAILEY JR. 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	207X00000X	Orthopaedic Surgery Physician	E-7064	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336368661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK S BAILEY JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 3250
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72018-3250
Country	:	US
Telephone Number	:	501-315-0984
Fax Number	:	501-847-1405

Provider Business Practice Location Address
First Line	:	2010 ACTIVE WAY
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-7566
Country	:	US
Telephone Number	:	501-315-0984
Fax Number	:	501-847-1405

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/16/2015

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