Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 013597 | MO |
NPI | 1003989948 |
---|---|
Provider Name | Fred E Bailey |
First Address | Kansas City, MO 64119 |
Second Address | Kansas City, MO 64119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |