Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 36 002126 | OH |
N | 2081S0010X | Sports Medicine | 36 002126 | OH |
N | 213ES0000X | Sports Medicine | 36 002126 | OH |
N | 213ES0103X | Foot & Ankle Surgery | 36 002126 | OH |
NPI | 1063416956 |
---|---|
Provider Name | Dr. Dan Steven Bailey |
First Address | Troy, OH 45373-2307 |
Second Address | Troy, OH 45373-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000011257 | ANTHEM ID (01) | OH |
0514152 | (05) | OH |
311071464-00 | WORKERS COMP ID (01) | OH |
T80552 | (02) | OH |