Provider Demographics
NPI:1962401513
Name:BAILEY, EDITH PROCTOR (MD)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:PROCTOR
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:PROCTOR (LAETSCH)
Other - Last Name:BAILEY-CRAIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2600 N WYATT DR
Mailing Address - Street 2:CHILDREN'S CLINICS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6106
Mailing Address - Country:US
Mailing Address - Phone:520-324-5437
Mailing Address - Fax:520-324-3129
Practice Address - Street 1:2600 N WYATT DR
Practice Address - Street 2:CHILDREN'S CLINICS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6106
Practice Address - Country:US
Practice Address - Phone:520-324-5437
Practice Address - Fax:520-324-3129
Is Sole Proprietor?:No
Enumeration Date:2005-07-16
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ125246Medicaid
AZAZ0881600OtherBC/BS
F56537Medicare UPIN
AZ125246Medicaid