Provider Demographics
NPI:1437115813
Name:BAILEY, JOHN TEMPLE (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TEMPLE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1804 MICCOSUKEE COMMONS
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-383-9991
Mailing Address - Fax:850-383-9993
Practice Address - Street 1:1804 MICCOSUKEE COMMONS
Practice Address - Street 2:SUITE 204
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-383-9991
Practice Address - Fax:850-383-9993
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS53492084P0800X
GA0457902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063833733Medicaid
FL80275Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL063833733Medicaid