Provider Demographics
NPI:1407117823
Name:BAUER, RICHARD LEE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
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 1:9616 MICRON AVE
Mailing Address - Street 2:SUITE 940
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827
Mailing Address - Country:US
Mailing Address - Phone:916-876-7854
Mailing Address - Fax:916-854-9479
Practice Address - Street 1:651 I ST.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814
Practice Address - Country:US
Practice Address - Phone:916-874-5183
Practice Address - Fax:916-874-4669
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine