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Individual
EVAN BAILY
Active
Individual
EVAN BAILY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58861
CA
363A00000X
Physician Assistant
PA031462
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA1800038
CONTROLLED SUBSTANCE REGISTRATION
DC
01
—
MA059187
PENNSYLVANIA BOARD OF MEDICINE
PA
01
—
OA004271
PENNSYLVANIA BOARD OF OSTEOPATHIC MEDICINE
PA
Enumeration date
12/22/2015
Last updated
03/07/2023
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