Basic Information
| Provider Information | |||||||||
| NPI: | 1467448894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | ROLLAND | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BAILEY | ||||||||
| OtherFirstName: | ROLLAND | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O., P.A. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 309 | ||||||||
| Address2: | 806 E MAIN | ||||||||
| City: | FLIPPIN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726340309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704532266 | ||||||||
| FaxNumber: | 8704532307 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 E MAIN | ||||||||
| Address2: | |||||||||
| City: | FLIPPIN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726340309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704532266 | ||||||||
| FaxNumber: | 8704532307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N6958 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110982003 | 05 | AR | MEDICAID |