Provider Demographics
NPI:1629210372
Name:BAUCOM, SIDNEY LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:LINCOLN
Last Name:BAUCOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SID
Other - Middle Name:
Other - Last Name:BAUCOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5848 S FASHION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6175
Mailing Address - Country:US
Mailing Address - Phone:801-314-5025
Mailing Address - Fax:801-314-4015
Practice Address - Street 1:5848 S FASHION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6175
Practice Address - Country:US
Practice Address - Phone:801-314-5025
Practice Address - Fax:801-314-4015
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9434735-1205207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery