Provider Demographics
NPI:1265619365
Name:BAILEY, CHARLES JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAMES
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 MEADOWWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8624
Mailing Address - Country:US
Mailing Address - Phone:734-576-5233
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIRCLE
Practice Address - Street 2:STC-7TH FLOOR VASCULAR SURGERY
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-821-8814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002604208600000X
FLME1131432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012769800Medicaid
FL012769800Medicaid