MEDICARE: ERIC BAUER ATC

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	174400000X	Specialist	1101	AZ

General Provider Information

NPI Number	:	1649657131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC BAUER ATC

Provider Business Mailing Address
First Line	:	3220 E BASELINE RD
Second Line	:	112
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7115
Country	:	US
Telephone Number	:	602-437-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 E BASELINE RD
Second Line	:	112
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7115
Country	:	US
Telephone Number	:	602-437-2225
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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