Provider Demographics
NPI:1063415354
Name:BAILEY, JOHN DEE (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:21469 LAKE WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7675
Mailing Address - Country:US
Mailing Address - Phone:660-627-0989
Mailing Address - Fax:660-627-0990
Practice Address - Street 1:1701 N ELSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1141
Practice Address - Country:US
Practice Address - Phone:660-665-0950
Practice Address - Fax:660-665-0699
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO110360207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244728507Medicaid
MO1831369107OtherGROUP NPI
MO000005399Medicare PIN
MO1831369107OtherGROUP NPI