Provider Demographics
NPI:1588688683
Name:BAUER, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:102 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NACHES
Practice Address - State:WA
Practice Address - Zip Code:98937-9743
Practice Address - Country:US
Practice Address - Phone:509-653-2235
Practice Address - Fax:509-653-2236
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020754207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107762Medicaid
WA0157289OtherLABOR & INDUSTRIES
WAP00123643OtherRAILROAD MEDICARE
WAAB38059Medicare Oscar/Certification
WAAB38068Medicare PIN
WA1107762Medicaid