Provider Demographics
NPI:1942265285
Name:BAUER, PAUL WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WADE
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:783 N. DENTON TAP RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-745-8400
Mailing Address - Fax:972-315-9011
Practice Address - Street 1:783 N. DENTON TAP RD
Practice Address - Street 2:STE 200
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-745-8400
Practice Address - Fax:972-315-9011
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3574207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152662603Medicaid
TX8F0669Medicare PIN
TXH65494Medicare UPIN
TX152662603Medicaid