MEDICARE: BAYLEY BEDFORD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336999614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAYLEY BEDFORD

Provider Business Mailing Address
First Line	:	2601 W 7TH ST APT 124
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2294
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3305
Country	:	US
Telephone Number	:	817-250-1506
Fax Number	:

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

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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Directions to “ BAYLEY BEDFORD ” Practice Location

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