Individual
BROCK A. BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3387 S US HIGHWAY 41, TERRE HAUTE, IN 47802-4188
(812) 232-5532
(812) 232-2574
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(217) 246-9128
(317) 962-4343
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002173A
IN
363AM0700X
Medical Physician Assistant
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Other
Enumeration date
12/04/2016
Last updated
03/09/2023
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