Basic Information
| Provider Information | |||||||||
| NPI: | 1780704445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 72030 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441920002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194795893 | ||||||||
| FaxNumber: | 4194795878 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192382390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 05/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35089010 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2733939 | 05 | OH | MEDICAID | P00742438 | 01 | OH | RAILROAD CARE | OTHER | P00427566 | 01 | OH | RAILROAD CARE | OTHER |