Provider Demographics
NPI:1982833554
Name:BAUER, JUDD P (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDD
Middle Name:P
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N 102ND CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2194
Mailing Address - Country:US
Mailing Address - Phone:402-502-2747
Mailing Address - Fax:402-502-2387
Practice Address - Street 1:1111 N 102ND CT STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2194
Practice Address - Country:US
Practice Address - Phone:402-502-2747
Practice Address - Fax:402-502-2387
Is Sole Proprietor?:No
Enumeration Date:2009-07-04
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6052207R00000X
NE27849207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP01352298OtherRR MEDICARE
IA1982833554Medicaid
NE1982833554OtherBCBS NE
IA543630002Medicare PIN
NEP01352298OtherRR MEDICARE
NE1982833554OtherBCBS NE