Provider Demographics
NPI:1811908619
Name:BAUMER, NATHAN B (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:B
Last Name:BAUMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NAT
Other - Middle Name:
Other - Last Name:BAUMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1717 ROTARY DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5235
Mailing Address - Country:US
Mailing Address - Phone:281-272-6277
Mailing Address - Fax:281-272-6281
Practice Address - Street 1:523 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4036
Practice Address - Country:US
Practice Address - Phone:805-275-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5803208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007737012OtherAETNA/PROIMA
TX105800006Medicaid
TX8U3450OtherBCBSTX/PROIMA
TXP00225681Medicare ID - Type UnspecifiedRAILROAD MEDICARE/PROIMA
TX105800006Medicaid
TX0007737012OtherAETNA/PROIMA