Provider Demographics
NPI:1952675969
Name:DALE V BAUMAN DR DALE V BAUMAN MD
Entity Type:Organization
Organization Name:DALE V BAUMAN DR DALE V BAUMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-752-1502
Mailing Address - Street 1:2300 HOSPITAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2166
Mailing Address - Country:US
Mailing Address - Phone:318-752-1502
Mailing Address - Fax:
Practice Address - Street 1:2300 HOSPITAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2166
Practice Address - Country:US
Practice Address - Phone:318-752-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04029R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2175874Medicaid
LA5J144Medicare PIN