Provider Demographics
NPI:1184998478
Name:BAUER, HEIDI MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MARIE
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 1:5115 FAIRHILL CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3829
Mailing Address - Country:US
Mailing Address - Phone:510-969-8397
Mailing Address - Fax:
Practice Address - Street 1:850 MARINA BAY PKWY # P-2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:510-620-3178
Practice Address - Fax:510-620-3180
Is Sole Proprietor?:No
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA670642083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine