Provider Demographics
NPI:1336252097
Name:BAER, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BAER
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 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:IA
Mailing Address - Zip Code:51551-8032
Mailing Address - Country:US
Mailing Address - Phone:712-624-6010
Mailing Address - Fax:712-357-2101
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:IA
Practice Address - Zip Code:51551-8032
Practice Address - Country:US
Practice Address - Phone:712-624-6010
Practice Address - Fax:712-357-2101
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1336252097Medicaid
NE47068731712Medicaid
NE47068731777Medicaid
IA1336252097Medicaid
IA48520Medicare PIN
IA48520Medicare PIN