1548228927 NPI number — STEVEN M BAUER MD

Table of content: STEVEN M BAUER MD (NPI 1548228927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548228927 NPI number — STEVEN M BAUER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUER
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUER
Provider Other First Name:
STEVEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548228927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20642 STONE OAK PKWY
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-7363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-492-0505
Provider Business Mailing Address Fax Number:
210-492-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20642 STONE OAK PKWY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-7362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-492-0505
Provider Business Practice Location Address Fax Number:
210-492-0504
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K2411 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00230501 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1177362 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8AW488 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0013JL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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