Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 16884 | KY |
NPI | 1174626352 |
---|---|
Provider Name | George W Bauer III |
First Address | Elizabethtown, KY 42701-2749 |
Second Address | Elizabethtown, KY 42701-2749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32707 | (02) | KY |
64168842 | (05) | KY |