Basic Information
| Provider Information | |||||||||
| NPI: | 1831349315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRADLEY B. BAILEY,MD AND ROGER B. SCHECHTER, MD, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | RESTORATIVE WOUND HEALING AND HYPERBARIC MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9600 CUYAMACA ST | ||||||||
| Address2: | SUITE 201A | ||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920712692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192586200 | ||||||||
| FaxNumber: | 6192580028 | ||||||||
| Practice Location | |||||||||
| Address1: | 15615 POMERADO RD | ||||||||
| Address2: | POMERADO WOUND CARE CENTER | ||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586134755 | ||||||||
| FaxNumber: | 8586134759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAILEY | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6192586200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | G85086 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No ID Information.