Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | J2924 | TX |
NPI | 1003990680 |
---|---|
Provider Name | Dr. John Gerard Baerenstecher |
First Address | Dallas, TX 75284-0853 |
Second Address | Dallas, TX 75240-6524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 09/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050049257 | RAILROAD MEDICARE (01) | TX |
136519908 | (05) | TX |
136519912 | (05) | TX |
136519913 | (05) | TX |
G08862 | (02) | TX |