MEDICARE: BAILEY JAMES SMITH

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1518704022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY JAMES SMITH

Provider Business Mailing Address
First Line	:	12212 W ROWEL RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-5929
Country	:	US
Telephone Number	:	623-670-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	10180 W HAPPY VALLEY PKWY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1389
Country	:	US
Telephone Number	:	623-670-4151
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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Directions to “ BAILEY JAMES SMITH ” Practice Location

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