MEDICARE: WALTER M BAIN MD

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	207Y00000X	Otolaryngology Physician	E4184	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	742630478	OTHER	CHAMPUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	86M432	OTHER	BCBS

General Provider Information

NPI Number	:	1194890863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER M BAIN MD

Provider Business Mailing Address
First Line	:	1303 MCCULLOUGH AVE
Second Line	:	STE 242
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-5604
Country	:	US
Telephone Number	:	210-226-8982
Fax Number	:	210-227-1736

Provider Business Practice Location Address
First Line	:	1303 MCCULLOUGH AVE
Second Line	:	STE 242
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-5604
Country	:	US
Telephone Number	:	210-226-8982
Fax Number	:	210-227-1736

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/29/2010

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