Basic Information
| Provider Information | |||||||||
| NPI: | 1417909078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMERT | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9753 QUAIL HOLLOW CT | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325145675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504711150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 W MORENO ST | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325012316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504378390 | ||||||||
| FaxNumber: | 8504378394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP9185727 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 59169967 | 01 | AL | BLUE SHIELD | OTHER | P00134532 | 01 | PALMETTO GBA - RR MEDICAR | OTHER | 59169966 | 01 | AL | BLUE SHIELD | OTHER | G3011 | 01 | FL | BLUE SHIELD | OTHER |