Provider Demographics
NPI:1003377631
Name:BAYER, STEPHAN ANTON
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:ANTON
Last Name:BAYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ELM ST APT 5
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4659
Mailing Address - Country:US
Mailing Address - Phone:719-287-6053
Mailing Address - Fax:
Practice Address - Street 1:205 ELM ST APT 5
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4659
Practice Address - Country:US
Practice Address - Phone:719-287-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical