Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 165202-1205 | UT |
NPI | 1013947845 |
---|---|
Provider Name | Thomas D. Bauman |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Salt Lake City, UT 84102-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 19/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A91489 | (02) |