Donovan Wilbur Bailey, M.D.
Individual provider Active NPI Family Medicine Physician · Lake Providence, LA
NPI 1790767481 · NPPES record last updated Oct 16, 2019
Key facts
- NPI
- 1790767481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 13596 (LA)
- Practice address
- 300 Scarborough St
Lake Providence, LA 71254-3018 - Phone
- (318) 559-2814
- Fax
- (318) 559-4226
- NPI assigned
- Nov 17, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13596 | LA | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13596 | LA | Yes |
Addresses
Primary practice location
300 Scarborough St
Lake Providence, LA 71254-3018
Mailing address
300 Scarborough St
Lake Providence, LA 71254-3018
Phone (318) 559-2814
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1171425 | Medicaid | LA | |
| 13596 | Other | LA | STATE LICENSE |
Other providers in Lake Providence, LA
- A & L Medical Supplies, LLC
- Styron D Allen
- At Home Adult Daycare
- Cathy Ann Baker
- Tamika Baker
- Alisa Bell
- Sheila Bell
- Patricia Brown
All providers in Lake Providence, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.