MEDICARE: MITCHELL EDWARD BAILEY M.D.

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	208600000X	Surgery Physician	G25349	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00270015	OTHER	CA	RAILROAD MEDICARE

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
3	00G253490	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1366422008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL EDWARD BAILEY M.D.

Provider Business Mailing Address
First Line	:	9030 W SAHARA AVE # 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5744
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

Provider Business Practice Location Address
First Line	:	30 MARK WEST SPRINGS RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1436
Country	:	US
Telephone Number	:	707-328-9673
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	10/26/2018

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