Provider Demographics
NPI:1407029762
Name:BAUER, JACOB HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:HOWARD
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 1:304 W BAY DR NW
Mailing Address - Street 2:STE 301
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4958
Mailing Address - Country:US
Mailing Address - Phone:360-413-8760
Mailing Address - Fax:
Practice Address - Street 1:304 W BAY DR NW
Practice Address - Street 2:STE 301
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4958
Practice Address - Country:US
Practice Address - Phone:360-413-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12612207N00000X, 207ND0101X
WAMD 60075013207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology