Provider Demographics
NPI:1144222506
Name:BAUER, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 NORTH FORTY DRIVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-432-4415
Mailing Address - Fax:314-432-1986
Practice Address - Street 1:12855 N 40 DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-432-4415
Practice Address - Fax:314-432-1986
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR8580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00616023OtherRAILROAD MEDICARE
129430001Medicare PIN
133640001Medicare PIN
P00616023OtherRAILROAD MEDICARE
A27978Medicare UPIN