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General NPI Number Information
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NPI Number | 1487041794
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Entity Type | Individual
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Provider Name | THOMAS ANTHONY BAUERS
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Gender | Male
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 1770 E VILLA DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4647
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Country | US
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Telephone | 928-202-0622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1165
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City | JEROME
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State | AZ
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Zip | 86331-1165
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Country | US
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Telephone |
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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 | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number | 24651
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 24651
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License Number State | AZ
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