Provider Demographics
NPI:1386971372
Name:HENRY I BAYLIS MD A PROF CORP
Entity type:Organization
Organization Name:HENRY I BAYLIS MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BAYLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-760-0700
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:# 605
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-760-0700
Mailing Address - Fax:949-760-9017
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:# 605
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-760-0700
Practice Address - Fax:949-760-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC254062086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty