Provider Demographics
NPI:1699845669
Name:BAUER, WINFRIED ERICH (MD)
Entity Type:Individual
Prefix:DR
First Name:WINFRIED
Middle Name:ERICH
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:PO BOX 751059
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94975-1059
Mailing Address - Country:US
Mailing Address - Phone:707-292-6698
Mailing Address - Fax:707-637-9263
Practice Address - Street 1:6854 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6127
Practice Address - Country:US
Practice Address - Phone:707-292-6698
Practice Address - Fax:707-537-7672
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29477Medicare ID - Type UnspecifiedCALIFORNIA LICENCE NUMBER