Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25327 | AZ |
NPI | 1477553543 |
---|---|
Provider Name | Dr. Richard Lefroy Bailey |
First Address | Bullhead City, AZ 86439-1944 |
Second Address | Bullhead City, AZ 86442-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G55860 | (02) | AZ |