Provider Demographics
NPI:1306096185
Name:BAILEY, ADAM RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:RICHARD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8662
Mailing Address - Country:US
Mailing Address - Phone:800-718-1259
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR STE 600
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8662
Practice Address - Country:US
Practice Address - Phone:800-718-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL-2686363A00000X
ORPA151485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant