Provider Demographics
NPI:1326029950
Name:BAUER, JASON RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RICHARD
Last Name:BAUER
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 1:25030 SW PARKWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9816
Mailing Address - Country:US
Mailing Address - Phone:503-612-0498
Mailing Address - Fax:503-459-0521
Practice Address - Street 1:25030 SW PARKWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-612-0498
Practice Address - Fax:503-459-0521
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26590202K00000X, 2085R0202X, 2085R0204X
WI30672085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240378Medicaid
ORR158531Medicare PIN
OR240378Medicaid