Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | L3574 | TX |
NPI | 1942265285 |
---|---|
Provider Name | Dr. Paul Wade Bauer |
First Address | Coppell, TX 75019 |
Second Address | Coppell, TX 75019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152662603 | (05) | TX |
H65494 | (02) | |
H65494 | (02) | TX |