Provider Demographics
NPI:1851391015
Name:BAUER, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:304 W BAY DR NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4958
Mailing Address - Country:US
Mailing Address - Phone:360-413-8760
Mailing Address - Fax:360-413-8839
Practice Address - Street 1:304 W BAY DR NW
Practice Address - Street 2:SUITE 301
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4958
Practice Address - Country:US
Practice Address - Phone:360-413-8760
Practice Address - Fax:360-413-8839
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017301207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8214603Medicaid
WAGAB20353OtherMEDICARE
WAA08317Medicare UPIN
WAAB20353Medicare ID - Type Unspecified