Provider Demographics
NPI:1033312632
Name:BAUER, BRENT J (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 22237
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:888-624-6882
Mailing Address - Fax:888-882-4498
Practice Address - Street 1:7125 SANGER RD STE 516
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-752-9638
Practice Address - Fax:254-752-2201
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN3488207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211558603Medicaid
TXN3488OtherLICENSE
BP2-0018483OtherINSTITUTIONAL PERMIT
TXN3488OtherLICENSE