MEDICARE: DR. RICHARD LEFROY 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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	25327	AZ

General Provider Information

NPI Number	:	1477553543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEFROY BAILEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 21944
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86439-1944
Country	:	US
Telephone Number	:	928-763-1020
Fax Number	:	928-763-2076

Provider Business Practice Location Address
First Line	:	3750 HWY 95
Second Line	:	SUITE 101
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6050
Country	:	US
Telephone Number	:	928-763-1020
Fax Number	:	928-763-2076

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/09/2020

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