Provider Demographics
NPI:1730268582
Name:BAHM, SANDY BERNARD II (MD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:BERNARD
Last Name:BAHM
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934
Mailing Address - Country:US
Mailing Address - Phone:979-733-0690
Mailing Address - Fax:979-733-0686
Practice Address - Street 1:420 WALNUT
Practice Address - Street 2:#209
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934
Practice Address - Country:US
Practice Address - Phone:979-733-0690
Practice Address - Fax:979-733-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5903207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099686002Medicaid
TX201539519OtherRAIL ROAD MEDICARE
TX099686002Medicaid
TX00P688Medicare ID - Type Unspecified
C13050Medicare UPIN