MEDICARE: RICHARD BAILEY, M.D., L.L.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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician

General Provider Information

NPI Number	:	1679761704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD BAILEY, M.D., L.L.C

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	:	728-763-2076

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD L BAILEY
Credential	:	M.D.
Telephone Number	:	928-763-1020

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	05/20/2008

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Directions to “RICHARD BAILEY, M.D., L.L.C ” Practice Location

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