Provider Demographics
NPI:1275597148
Name:BAUZA, JOSE ARMSTRONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ARMSTRONG
Last Name:BAUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:P. O. BOX 3845
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3845
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-774-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0320962085N0700X, 2085R0202X, 2085D0003X, 2085B0100X, 2085N0904X, 2085P0229X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00503082GMedicaid
1265540314OtherNPI - BROWN & RADIOLOGY
GA598103OtherBLUE CROSS BLUE SHIELD
SCG32096Medicaid
GA00503082DMedicaid
GA00503082EMedicaid
GA00503082FMedicaid
GA00503082HMedicaid
GA00503082KMedicaid
GA00503082CMedicaid
GA00503082LMedicaid
10058261OtherAMERIGROUP
GA00503082IMedicaid
GA00503082JMedicaid
GA00503082KMedicaid
GA00503082LMedicaid