Provider Demographics
NPI:1619205531
Name:BAUER, PAUL ELDON II (IDC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ELDON
Last Name:BAUER
Suffix:II
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:USS BARRY DDG 52
Mailing Address - Street 2:09565-1270
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09565-1270
Mailing Address - Country:US
Mailing Address - Phone:757-444-1152
Mailing Address - Fax:757-444-1152
Practice Address - Street 1:USS BARRY DDG 52
Practice Address - Street 2:09565-1270
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09565-1270
Practice Address - Country:US
Practice Address - Phone:757-444-1152
Practice Address - Fax:757-444-1152
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0000001710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman