Basic Information
| Provider Information | |||||||||
| NPI: | 1083697874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MITCHELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945STATE ROUTE 33 | ||||||||
| Address2: | JERSEY SHORE UNIVERSITY MEDICAL CENTER | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327755500 | ||||||||
| FaxNumber: | 7327764843 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 STATE ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327764949 | ||||||||
| FaxNumber: | 7327764843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 14321 | MS | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 14321 | MS | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 14321 | MS | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0129X | 14321 | MS | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | 14321 | MS | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 02312412 | 05 | NY | MEDICAID |