Individual
MITCHELL EDWARD BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 MARK WEST SPRINGS RD, SANTA ROSA, CA 95403-1436
(707) 328-9673
Mailing address
9030 W SAHARA AVE # 118, LAS VEGAS, NV 89117-5744
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G25349
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G253490
BLUE SHIELD OF CALIFORNIA
CA
05
—
00G253490
—
CA
01
—
P00270015
RAILROAD MEDICARE
CA
Enumeration date
01/19/2006
Last updated
10/26/2018
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