Provider Demographics
NPI:1508082132
Name:BAUMAN, WENDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDALL
Middle Name:
Last Name:BAUMAN
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 1:11651 TOEPPERWEIN RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3147
Mailing Address - Country:US
Mailing Address - Phone:210-654-0400
Mailing Address - Fax:210-654-0460
Practice Address - Street 1:11651 TOEPPERWEIN RD
Practice Address - Street 2:STE 201
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3147
Practice Address - Country:US
Practice Address - Phone:210-654-0400
Practice Address - Fax:210-654-0460
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034567003Medicaid
TX034567003Medicaid
TXE56646Medicare UPIN