Healthcare Provider Details

I. General information

NPI: 1780838789
Provider Name (Legal Business Name): NISHA RAY BAUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215 BOX RAMSTEIN
APO AE
09094-3215
US

IV. Provider business mailing address

7612 S 2800 E
SOUTH WEBER UT
84405-9627
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2273
  • Fax:
Mailing address:
  • Phone: 801-920-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7152185-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberFB1143647
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7152185-1204
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number7152185-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: