1629366232 NPI number — DR. JASON RAYMOND BAILEY D.P.M.

Table of content: DR. JASON RAYMOND BAILEY D.P.M. (NPI 1629366232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629366232 NPI number — DR. JASON RAYMOND BAILEY D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
JASON
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629366232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N 27TH ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-844-8158
Provider Business Mailing Address Fax Number:
402-844-8159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 W NORFOLK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-844-8158
Provider Business Practice Location Address Fax Number:
402-844-8159
Provider Enumeration Date:
07/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  344 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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