Provider Demographics
NPI:1609844034
Name:BAUMAN, DALE V (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:V
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2300 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2166
Mailing Address - Country:US
Mailing Address - Phone:318-752-1502
Mailing Address - Fax:318-752-1504
Practice Address - Street 1:2300 HOSPITAL DR
Practice Address - Street 2:#310
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2394
Practice Address - Country:US
Practice Address - Phone:318-752-1502
Practice Address - Fax:318-752-1504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04029R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE5348OtherTX STATE MEDICAL LIC
LA04029ROtherLA STATE MEDICAL LIC
LA1303976Medicaid
LAB60325Medicare UPIN
LA5J144Medicare ID - Type Unspecified