Basic Information
| Provider Information | |||||||||
| NPI: | 1629004213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMAN | ||||||||
| FirstName: | RANDELL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2429 | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983620311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604177365 | ||||||||
| FaxNumber: | 3604527303 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 CAROLINE ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983623910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604177365 | ||||||||
| FaxNumber: | 3604527303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00044431 | WA | Y | Other Service Providers | Specialist |
No ID Information.