Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 11867 | NV |
Y | 207PP0204X | Pediatric Emergency Physician | MD20461 | OR |
NPI | 1033279633 |
---|---|
Provider Name | Beverly H. Bauman |
First Address | Klamath Falls, OR 97601-1106 |
Second Address | Klamath Falls, OR 97601-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150915 | (05) | OR |
F34172 | (02) | NV |