Provider Demographics
NPI:1679520019
Name:BAILEY, JEANNE SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:SUZANNE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9589
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-4589
Mailing Address - Country:US
Mailing Address - Phone:208-472-8123
Mailing Address - Fax:208-344-1926
Practice Address - Street 1:600 ROBBINS RD
Practice Address - Street 2:SUITE 401
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4565
Practice Address - Country:US
Practice Address - Phone:208-489-4279
Practice Address - Fax:208-424-8555
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6245207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93031Medicare UPIN
ID1129104Medicare ID - Type Unspecified