Provider Demographics
NPI:1417392481
Name:BAUER, BENJAMIN HEBER (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HEBER
Last Name:BAUER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BROOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7850
Mailing Address - Country:US
Mailing Address - Phone:801-380-7419
Mailing Address - Fax:
Practice Address - Street 1:3777 PECOS MCLEOD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4265
Practice Address - Country:US
Practice Address - Phone:720-434-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2015213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery