Provider Demographics
NPI:1669451084
Name:BAUER, THOMAS ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDERSON
Last Name:BAUER
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 1:602 SOUTH BUCKEYE AVENUE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67578
Mailing Address - Country:US
Mailing Address - Phone:620-234-6073
Mailing Address - Fax:620-234-6085
Practice Address - Street 1:602 SOUTH BUCKEYE AVENUE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:KS
Practice Address - Zip Code:67578
Practice Address - Country:US
Practice Address - Phone:620-234-6073
Practice Address - Fax:620-234-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100081810 AMedicaid
KS100081810AMedicaid
KS000485Medicare ID - Type Unspecified
KSB68280Medicare UPIN
KS100081810AMedicaid