Provider Demographics
NPI:1043290042
Name:BAILEY, ROBERT B JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1920 E CAMBRIDGE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1459
Mailing Address - Country:US
Mailing Address - Phone:602-279-1697
Mailing Address - Fax:602-264-0461
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-279-1697
Practice Address - Fax:602-264-0461
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17021208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ271172Medicaid
D43672Medicare UPIN
103742Medicare ID - Type Unspecified