Basic Information
| Provider Information | |||||||||
| NPI: | 1336423516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 N TRACY BLVD | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953763451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098326018 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1420 N TRACY BLVD | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953763451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098326018 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A125644 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.