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Organization

SUSAN R. BAILEY, M.D.P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELLEN ROGERS (INSURANCE SUPERVISOR)
(817) 315-2550
Entity
Organization

Contact information

Practice address
5929 LOVELL AVE, FORT WORTH, TX 76107-5029
(817) 315-2550
(817) 732-4660
Mailing address
5929 LOVELL AVE, FORT WORTH, TX 76107-5029
(817) 315-2550
(817) 732-4660

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G0037
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
032156401
TX
Enumeration date
06/26/2008
Last updated
12/31/2008
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