Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 17021 | AZ |
NPI | 1043290042 |
---|---|
Provider Name | Robert B. Bailey JR. |
First Address | Phoenix, AZ 85006-1459 |
Second Address | Phoenix, AZ 85006-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 25/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271172 | (05) | AZ |
D43672 | (02) |