Healthcare Provider Details

I. General information

NPI: 1730268582
Provider Name (Legal Business Name): SANDY BERNARD BAHM II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WALNUT #209
COLUMBUS TX
78934
US

IV. Provider business mailing address

PO BOX 580
COLUMBUS TX
78934
US

V. Phone/Fax

Practice location:
  • Phone: 979-733-0690
  • Fax: 979-733-0686
Mailing address:
  • Phone: 979-733-0690
  • Fax: 979-733-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD5903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: