Provider Demographics
NPI:1538422779
Name:BAILEY, GEORGE C (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE STE 1205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1812
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:4312 HERITAGE TRACE PKWY STE 700
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:214-915-8506
Practice Address - Fax:682-223-5006
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR3794208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606598YNEDOtherMEDICARE DALLAS
TX606598YNECOtherMEDICARE
TX606598YND4OtherMEDICARE 99
MN340001292Medicare PIN