Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MO110360 | MO |
NPI | 1063415354 |
---|---|
Provider Name | Dr. John Dee Bailey |
First Address | Kirksville, MO 63501-7675 |
Second Address | Kirksville, MO 63501-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 16/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1831369107 | GROUP NPI (01) | MO |
244728507 | (05) | MO |
G44875 | (02) | MO |