Individual
DR. DONOVAN WILBUR BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 SCARBOROUGH ST, LAKE PROVIDENCE, LA 71254-3018
(318) 559-2814
(318) 559-4226
Mailing address
300 SCARBOROUGH ST, LAKE PROVIDENCE, LA 71254-3018
(318) 559-2814
(318) 559-4226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13596
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171425
—
LA
01
—
13596
STATE LICENSE
LA
Enumeration date
11/17/2005
Last updated
10/16/2019
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