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General NPI Number Information
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NPI Number | 1417392481
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Entity Type | Individual
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Provider Name | BENJAMIN HEBER BAUER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 3777 PECOS MCLEOD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89121-4265
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Country | US
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Telephone | 720-434-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 BROOMFIELD DR
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City | HENDERSON
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State | NV
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Zip | 89074-7850
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Country | US
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Telephone | 801-380-7419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2015
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License Number State | NV
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