Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7534 | IA |
NPI | 1003875857 |
---|---|
Provider Name | Dr. Shawn J Bailey |
First Address | Davenport, IA 52807-2764 |
Second Address | Davenport, IA 52807-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1176925 | (05) | IA |
2176925 | (05) | IA |
45328 | (02) | |
U71478 | (02) | IA |