Provider Demographics
NPI:1861422685
Name:BAUER, MARC GARY (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:GARY
Last Name:BAUER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:821 N COLEMAN ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2303
Mailing Address - Country:US
Mailing Address - Phone:469-800-5200
Mailing Address - Fax:469-800-5210
Practice Address - Street 1:821 N COLEMAN ST
Practice Address - Street 2:SUITE #100
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2303
Practice Address - Country:US
Practice Address - Phone:469-800-5200
Practice Address - Fax:469-800-5210
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0775764Medicaid
TX135319516Medicaid
TX322453YKY6Medicare PIN
E61025Medicare UPIN