Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60937352 | WA |
Y | 208600000X | Surgeon | MD60937352 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | R6336 | TX |
NPI | 1003179300 |
---|---|
Provider Name | Chad Michael Bailey |
First Address | Renton, WA 98055-6230 |
Second Address | Renton, WA 98055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
387114701 | (05) | TX |
387114702 | (05) | TX |
8JM817 | BCBS (01) | TX |
RES000 | (02) | CA |