MEDICARE: DR. PAUL WADE BAUER 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	207YP0228X	Pediatric Otolaryngology Physician	L3574	TX

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	:	1942265285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WADE BAUER MD

Provider Business Mailing Address
First Line	:	783 N. DENTON TAP RD.
Second Line	:	SUITE 200
City	:	COPPELL
State	:	TX
Zip	:	75019
Country	:	US
Telephone Number	:	972-745-8400
Fax Number	:	972-315-9011

Provider Business Practice Location Address
First Line	:	783 N. DENTON TAP RD
Second Line	:	STE 200
City	:	COPPELL
State	:	TX
Zip	:	75019
Country	:	US
Telephone Number	:	972-745-8400
Fax Number	:	972-315-9011

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2013

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