Provider Demographics
NPI:1487877528
Name:BAUER, BRIAN DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:BAUER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741235
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-1235
Mailing Address - Country:US
Mailing Address - Phone:954-941-2679
Mailing Address - Fax:954-941-6169
Practice Address - Street 1:10017 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1000
Practice Address - Country:US
Practice Address - Phone:954-916-1133
Practice Address - Fax:954-916-0096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL7924111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7924OtherLISCENSE NUMBER