Provider Demographics
NPI:1700868833
Name:BAUER, EVAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:G
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:SUITE C-600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-866-3344
Mailing Address - Fax:602-375-2088
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE C-600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-866-3344
Practice Address - Fax:602-375-2088
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ13703207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
121777OtherHEALTHNET
AZ0051960OtherBCBS
AZ1407058324OtherORGANIZATION NPI#
121777OtherHEALTHNET
AZE3930Medicare UPIN