MEDICARE: MRS. LEAH HOPE BAYLISS PA-C

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	363AS0400X	Surgical Physician Assistant	PA05645	TX
2	363A00000X	Physician Assistant	PA05645	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y8336	OTHER	TX	BCBSTX
2	PA05645	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1396922779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH HOPE BAYLISS PA-C

Provider Business Mailing Address
First Line	:	2018 EBONY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-5025
Country	:	US
Telephone Number	:	832-922-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 EBONY LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-5025
Country	:	US
Telephone Number	:	832-922-3839
Fax Number	:

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	05/19/2011

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