Provider Demographics
NPI:1003873639
Name:BAUER, MEGGAN E (MD)
Entity type:Individual
Prefix:
First Name:MEGGAN
Middle Name:E
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 E CAMELBACK RD STE K100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8374
Mailing Address - Country:US
Mailing Address - Phone:602-224-9218
Mailing Address - Fax:
Practice Address - Street 1:4250 E CAMELBACK RD STE K100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8374
Practice Address - Country:US
Practice Address - Phone:602-224-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14845Medicare UPIN