Provider Demographics
NPI:1144320342
Name:BAUER UROLOGY CLINIC, LLC
Entity type:Organization
Organization Name:BAUER UROLOGY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND 100 OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-215-3601
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35011-0159
Mailing Address - Country:US
Mailing Address - Phone:256-215-3601
Mailing Address - Fax:
Practice Address - Street 1:125 ALISON DR STE 2
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4410
Practice Address - Country:US
Practice Address - Phone:256-215-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22601208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9193345OtherPHYSICIAN HEALTHCARE SVCS
AL51526132OtherBCBS OF AL PROVIDER #
AL1950797OtherCCN/JSL ADMINISTRATORS IN
AL1457352684OtherIND. NPI # FOR DR.BAUER
ALPOO276233OtherPALMETTO GBA - RAILROAD
AL1950797OtherCCN/JSL ADMINISTRATORS IN
AL=========OtherTRICARE
AL9193345OtherPHYSICIAN HEALTHCARE SVCS