Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | M-2647 | ID |
NPI | 1528284981 |
---|---|
Provider Name | Gerald Charles Bauman |
First Address | Caldwell, ID 83605-5321 |
Second Address | Caldwell, ID 83605-5321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |