MEDICARE: THOMAS W BAUCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	24557	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124011713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS W BAUCH M.D.

Provider Business Mailing Address
First Line	:	11209 N TATUM BLVD
Second Line	:	175
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-652-8900
Fax Number	:	602-652-8909

Provider Business Practice Location Address
First Line	:	11209 N TATUM BLVD
Second Line	:	175
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-652-8900
Fax Number	:	602-652-8909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	10/20/2010

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