Provider Demographics
NPI:1093189672
Name:BAER, BRIAN DAVID (NP-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:BAER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1421
Mailing Address - Country:US
Mailing Address - Phone:317-881-9792
Mailing Address - Fax:317-882-1766
Practice Address - Street 1:223 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1421
Practice Address - Country:US
Practice Address - Phone:317-881-9792
Practice Address - Fax:317-882-1766
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005986B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201339880Medicaid