Healthcare Provider Details

I. General information

NPI: 1831272863
Provider Name (Legal Business Name): KARL BRUNO BAURICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 30TH AVE
FAIRBANKS AK
99701-7423
US

IV. Provider business mailing address

1626 30TH AVE.
FAIRBANKS AK
99701
US

V. Phone/Fax

Practice location:
  • Phone: 907-479-7701
  • Fax: 907-479-7718
Mailing address:
  • Phone: 907-479-7701
  • Fax: 907-479-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number3746
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: