Basic Information
| Provider Information | |||||||||
| NPI: | 1346551314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | THURSTON | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 KANIS RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012556336 | ||||||||
| FaxNumber: | 5012556409 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 SAINT VINCENT CIR | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016662894 | ||||||||
| FaxNumber: | 5016669017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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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 | 208G00000X | E-9804 | AR | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.