Healthcare Provider Details

I. General information

NPI: 1881756351
Provider Name (Legal Business Name): SANDY B BAHM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WALNUT #209
COLUMBUS TX
78934
US

IV. Provider business mailing address

420 WALNUT #209
COLUMBUS TX
78934
US

V. Phone/Fax

Practice location:
  • Phone: 979-733-0690
  • Fax: 214-221-5600
Mailing address:
  • Phone: 979-733-0690
  • Fax: 214-221-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDY B BAHM
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 979-733-0690