Provider Demographics
NPI:1134294770
Name:BRUCE BAUGHER D.O., PC
Entity Type:Organization
Organization Name:BRUCE BAUGHER D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BAUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-763-5900
Mailing Address - Street 1:1908 N 14TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2014
Mailing Address - Country:US
Mailing Address - Phone:580-763-5900
Mailing Address - Fax:580-763-5901
Practice Address - Street 1:1908 N 14TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2014
Practice Address - Country:US
Practice Address - Phone:580-763-5900
Practice Address - Fax:580-763-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7114671OtherAETNA
OKP00252783OtherRAILROAD MEDICARE
OK446487280001OtherBLUE CROSS BLUE SHIELD
OK200059980DMedicaid
OK200059980DMedicaid
OK400522513Medicare PIN