Individual
JACOB WALTER BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2808 N 75TH ST STE H, OMAHA, NE 68134-6861
(402) 932-2248
Mailing address
PO BOX 208004, NEW HAVEN, CT 06520-8004
(203) 737-2284
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
NA
AL
363A00000X
Physician Assistant
Primary
2827
NE
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
2827
NE
Other
Enumeration date
04/05/2022
Last updated
02/14/2023
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