Provider Demographics
NPI:1215907126
Name:BAYLOR, MICHAEL RANDEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RANDEL
Last Name:BAYLOR
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:PO BOX 11647
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1647
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:459 LOCUST AVE
Practice Address - Street 2:MB #26
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4808
Practice Address - Country:US
Practice Address - Phone:434-982-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223301207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA224878OtherSOUTHERN HEALTH
VA40565OtherCOMMUNITY HEALTH
VA930113913OtherMEDICARE PIN
VA010134081Medicaid
VA40565Medicaid
VA010046220Medicaid
VA165761OtherANTHEM SVC/HEALTHKEEPERS
VAP00192026OtherMEDICARE PIN
VAP00192026OtherMEDICARE PIN
VA010046220Medicaid
VA00W289P04Medicare PIN