Provider Demographics
NPI:1215126586
Name:AMELIA EAR NOSE & THROAT PC
Entity type:Organization
Organization Name:AMELIA EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-321-1417
Mailing Address - Street 1:1340 S 18TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FERNANDINA
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4733
Mailing Address - Country:US
Mailing Address - Phone:904-321-1417
Mailing Address - Fax:904-321-1418
Practice Address - Street 1:1340 S 18TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FERNANDINA
Practice Address - State:FL
Practice Address - Zip Code:32034-4733
Practice Address - Country:US
Practice Address - Phone:904-321-1417
Practice Address - Fax:904-321-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86839207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7199Medicare PIN