Healthcare Provider Details

I. General information

NPI: 1255048054
Provider Name (Legal Business Name): JOHN BAUER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MISSION AVE
SPOKANE WA
99201-2322
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-4343
  • Fax: 509-329-2280
Mailing address:
  • Phone: 509-865-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61354819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: