Provider Demographics
NPI:1417909078
Name:BAUMERT, GERALD J (CRNA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:BAUMERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9753 QUAIL HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5675
Mailing Address - Country:US
Mailing Address - Phone:850-471-1150
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-437-8390
Practice Address - Fax:850-437-8394
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9185727367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59169967OtherBLUE SHIELD
P00134532OtherPALMETTO GBA - RR MEDICAR
AL59169966OtherBLUE SHIELD
FLG3011OtherBLUE SHIELD
AL59169966OtherBLUE SHIELD