Provider Demographics
NPI:1396819173
Name:BACHUS, LOIS A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:A
Last Name:BACHUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE B-250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6888
Mailing Address - Country:US
Mailing Address - Phone:512-462-1717
Mailing Address - Fax:512-462-0822
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:SUITE B-250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6888
Practice Address - Country:US
Practice Address - Phone:512-462-1717
Practice Address - Fax:512-462-0822
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7033207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0832479-01Medicaid
TX88M092OtherBCBS--INDIVIDUAL
TXG7033OtherTX LICENSE
TX1229171-03Medicaid
TX130305100OtherFIRST CARE ID
TX0832479-01Medicaid
TX88M091Medicare ID - Type UnspecifiedMCR-INDIVIDUAL ID
TX88M092OtherBCBS--INDIVIDUAL