Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT27088 | CA |
NPI | 1043290554 |
---|---|
Provider Name | Mr. Jared M Bailey |
First Address | Santa Maria, CA 93454 |
Second Address | Santa Maria, CA 93454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WPT27088C | (02) | CA |