Provider Demographics
NPI:1871724310
Name:BAYLESS, RONNIE DAVID JR (IDC)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:DAVID
Last Name:BAYLESS
Suffix:JR
Gender:M
Credentials:IDC
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Mailing Address - Street 1:2D MARINE SPECIAL OPERATION BATTALION
Mailing Address - Street 2:PSC BOX 20183
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-0183
Mailing Address - Country:US
Mailing Address - Phone:910-450-7704
Mailing Address - Fax:910-450-7059
Practice Address - Street 1:2D MARINE SPECIAL OPERATION BATTALION
Practice Address - Street 2:PSC BOX 20183
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28540-0183
Practice Address - Country:US
Practice Address - Phone:910-450-7704
Practice Address - Fax:910-450-7059
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman