Provider Demographics
NPI:1699044461
Name:GEORGE P. BAUER MD
Entity Type:Organization
Organization Name:GEORGE P. BAUER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-860-4771
Mailing Address - Street 1:2960 MACK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5373
Mailing Address - Country:US
Mailing Address - Phone:513-860-4771
Mailing Address - Fax:513-860-4770
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-860-4771
Practice Address - Fax:513-860-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064650207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366547531OtherNPI
OH0924227Medicaid
1366547531OtherNPI
OH0924227Medicaid