Provider Demographics
NPI:1235170366
Name:BAUMAN, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-945-4787
Mailing Address - Fax:405-945-4383
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-945-4787
Practice Address - Fax:405-945-4383
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK17051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD28726Medicare UPIN
OK243435201Medicare ID - Type UnspecifiedMEDICARE NUMBER
OK900522214Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER