Individual
RICHARD C BAILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4000
(701) 234-4160
Mailing address
PO BOX 2010, FARGO, ND 58122-0605
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
19797
MN
2084N0400X
Neurology Physician
Primary
3760
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12714
—
ND
Enumeration date
07/16/2006
Last updated
12/29/2011
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