Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3807-015 | WI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 6931 | CO |
NPI | 1003893249 |
---|---|
Provider Name | Dr. Mark Richard Baus |
First Address | Tripler Amc, HI 96859-5000 |
Second Address | Tripler Amc, HI 96859-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/07/2007 |