Provider Demographics
NPI:1316963416
Name:BAILEY, ROBERT BLAIR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLAIR
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 COUNTS MASSIE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6656
Mailing Address - Country:US
Mailing Address - Phone:501-224-0330
Mailing Address - Fax:501-224-0356
Practice Address - Street 1:7635 COUNTS MASSIE RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6656
Practice Address - Country:US
Practice Address - Phone:501-224-0330
Practice Address - Fax:501-224-0356
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR112590-60-0011744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48390OtherBC/BS
AR1120230001Medicare NSC