Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 02799 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 02799 | KY |
NPI | 1275602070 |
---|---|
Provider Name | Christopher M Bailey |
First Address | Prestonsburg, KY 41653-1080 |
Second Address | Prestonsburg, KY 41653-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 14/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64061336 | (05) | KY |
H74899 | (02) |