Provider Demographics
NPI:1215931639
Name:BAILEY, MICHAEL LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 N TARRANT PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8645
Mailing Address - Country:US
Mailing Address - Phone:817-562-2339
Mailing Address - Fax:817-562-1342
Practice Address - Street 1:3418 N TARRANT PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8645
Practice Address - Country:US
Practice Address - Phone:817-562-2339
Practice Address - Fax:817-562-1342
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-02-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-06-09
Provider Licenses
StateLicense IDTaxonomies
TXK5446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201660202Medicaid
TX130929606Medicaid
TX130929614Medicaid
TX130929605Medicaid
TXP01037952OtherRAILROAD
TX201660201Medicaid
TXG81356Medicare UPIN
TX130929606Medicaid
TX130929614Medicaid
TXTXB148548Medicare PIN