Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 037131 | GA |
NPI | 1033105416 |
---|---|
Provider Name | Dr. Evan C Bahr |
First Address | Augusta, GA 30904-6220 |
Second Address | Augusta, GA 30904-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 07/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00564825A | (05) | GA |
F63702 | (02) | GA |
G37131 | MEDICAID (01) | SC |