Provider Demographics
NPI:1871546598
Name:BAILEY, CECIL CEDRIC (MD)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:CEDRIC
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N JOE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1430
Mailing Address - Country:US
Mailing Address - Phone:972-299-0003
Mailing Address - Fax:972-299-0004
Practice Address - Street 1:1121 N JOE WILSON RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1430
Practice Address - Country:US
Practice Address - Phone:972-299-0003
Practice Address - Fax:972-299-0004
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030731605Medicaid
TX030731601Medicaid
TX030731604Medicaid
TXP00063559OtherRAILROAD MEDICARE
TX030731605Medicaid
TXP00063559OtherRAILROAD MEDICARE
TXTXB112718Medicare PIN
TX8F9429Medicare PIN