Provider Demographics
NPI:1982838793
Name:BAUERMEISTER, RYAN MICHAEL (IDMT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MICHAEL
Last Name:BAUERMEISTER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 QUEEN EMMA ST
Mailing Address - Street 2:1905
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6300
Mailing Address - Country:US
Mailing Address - Phone:808-250-9317
Mailing Address - Fax:
Practice Address - Street 1:1200 QUEEN EMMA ST
Practice Address - Street 2:1905
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6300
Practice Address - Country:US
Practice Address - Phone:808-250-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians