Provider Demographics
NPI:1194800052
Name:BAILEY, TIMOTHY SILLECK (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SILLECK
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 1:625 W CITRACADO PKWY STE 108
Mailing Address - Street 2:STE 108
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-743-1431
Mailing Address - Fax:760-743-6455
Practice Address - Street 1:625 CITRACADO PKWY STE 108
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-743-1431
Practice Address - Fax:760-743-6455
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60763174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W3171OtherPTAN FOR MEDICARE SOUTH
CA00G60763Medicaid
ZZZ37242ZOtherPTAN FOR MEDICARE NORTH
AS316XOtherDR. BAILEY'S PTAN