Provider Demographics
NPI:1144608266
Name:BAHR DERMATOLOGY PC
Entity Type:Organization
Organization Name:BAHR DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-298-1514
Mailing Address - Street 1:25 W 500 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7126
Mailing Address - Country:US
Mailing Address - Phone:801-298-1514
Mailing Address - Fax:801-298-1841
Practice Address - Street 1:25 W 500 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7126
Practice Address - Country:US
Practice Address - Phone:801-298-1514
Practice Address - Fax:801-298-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3735441205207N00000X
207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty