1164401634 NPI number — BONNIE MARIE GAUER OD

Table of content: BONNIE MARIE GAUER OD (NPI 1164401634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164401634 NPI number — BONNIE MARIE GAUER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAUER
Provider First Name:
BONNIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164401634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 NW MEDICAL LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-440-2590
Provider Business Mailing Address Fax Number:
541-440-9285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 NW MEDICAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-2590
Provider Business Practice Location Address Fax Number:
541-440-9285
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3054AT , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 3097TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06254900000 . This is a "REGENCE BCBS REGULAR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 126636 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731676813 . This is a "SAIF CORP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 289F9GA . This is a "BCBS MINNESOTA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "LIFEWISE OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "PYRAMID LIFE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "PROVIDENCE HEALTH" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 09042 . This is a "PACIFICSOURCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CR0000PHDBR . This is a "UNITED AM INS CO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: P00087069 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 73167681308E729 . This is a "REGENCE BCBS FED PROG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: PR47149760001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 430347-01 . This is a "REGENCE BCBS PC65" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "ODS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "STATE FARM INSURANCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813974700000 . This is a "TRIWEST/TRICARE/CHAMPUS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 731676813 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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