Provider Demographics
NPI:1235108473
Name:BAUER, WILLIAM CORNELIUS (MD LLC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CORNELIUS
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91075
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-1075
Mailing Address - Country:US
Mailing Address - Phone:702-685-0674
Mailing Address - Fax:702-566-4575
Practice Address - Street 1:6000 W ROCHELLE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3376
Practice Address - Country:US
Practice Address - Phone:702-685-0674
Practice Address - Fax:702-566-4575
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMD66142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVMD6614Medicare UPIN