Provider Demographics
NPI:1770913592
Name:BAZE MEDICAL PLLC
Entity type:Organization
Organization Name:BAZE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELSCHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-281-0402
Mailing Address - Street 1:1709 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3131
Mailing Address - Country:US
Mailing Address - Phone:817-281-0402
Mailing Address - Fax:
Practice Address - Street 1:1709 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3131
Practice Address - Country:US
Practice Address - Phone:817-281-0402
Practice Address - Fax:817-281-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty