MEDICARE: BEAU BAILEY 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	208000000X	Pediatrics Physician	9247403-1205	UT
2	207R00000X	Internal Medicine Physician	9247403-1205	UT

General Provider Information

NPI Number	:	1417247677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEAU BAILEY MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-387-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 HARRISON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-3195
Country	:	US
Telephone Number	:	801-387-3364
Fax Number	:

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/13/2026

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Directions to “ BEAU BAILEY MD” Practice Location

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