Basic Information
| Provider Information | |||||||||
| NPI: | 1699054270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JASON R BAILEY MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 980790 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770989998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817415910 | ||||||||
| FaxNumber: | 7135831113 | ||||||||
| Practice Location | |||||||||
| Address1: | 12121 RICHMOND AVENUE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770822420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817415910 | ||||||||
| FaxNumber: | 7135831113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2011 | ||||||||
| LastUpdateDate: | 11/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | ATWOOD | ||||||||
| AuthorizedOfficialFirstName: | CANDICE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2817411520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086S0122X | M6030 | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.