Provider Demographics
NPI:1386878080
Name:BAILEY, MATTHEW BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRUCE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:LCSB - 2
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4271
Mailing Address - Fax:859-258-4296
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:LCSB - 2
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4271
Practice Address - Fax:859-258-4296
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
KY47015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN