Provider Demographics
NPI:1881853984
Name:WALTER E BAUMANN M.D. , INC
Entity Type:Organization
Organization Name:WALTER E BAUMANN M.D. , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-756-4608
Mailing Address - Street 1:1214 S BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6310
Mailing Address - Country:US
Mailing Address - Phone:918-756-4608
Mailing Address - Fax:918-756-4611
Practice Address - Street 1:1214 S BELMONT AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6310
Practice Address - Country:US
Practice Address - Phone:918-756-4608
Practice Address - Fax:918-756-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10254208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100189280AMedicaid
1006730001Medicare NSC
OK100189280AMedicaid