Provider Demographics
NPI:1366547531
Name:BAUER, GEORGE PAUL (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PAUL
Last Name:BAUER
Suffix:
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 1:311 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3991
Practice Address - Country:US
Practice Address - Phone:513-910-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064650207Y00000X
IN01040998A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0924227Medicaid
IN300014629Medicaid
000001175701OtherANTHEM
OH4496001OtherAETNA
OH311440455-00OtherWORKMANS COMPENSATION
OH0924227Medicaid
OH040009544OtherRAILROAD MEDICARE
OH311440455026OtherCARESOURCE
OH0745163Medicare ID - Type UnspecifiedWESTERN HILLS