=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083888242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL STEPHEN BAYER M,D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2008
-----------------------------------------------------
Last Update Date | 04/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 CATAMARAN LN
-----------------------------------------------------
City | OKATIE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29909-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-645-4406
-----------------------------------------------------
Fax | 843-645-4407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 CATAMARAN LN
-----------------------------------------------------
City | OKATIE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29909-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-645-4406
-----------------------------------------------------
Fax | 843-645-4407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 25MA02049200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------