Provider Demographics
NPI:1457352171
Name:BAHR, ALBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:BAHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1615
Mailing Address - Country:US
Mailing Address - Phone:801-713-4402
Mailing Address - Fax:801-262-8118
Practice Address - Street 1:396 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1615
Practice Address - Country:US
Practice Address - Phone:801-713-4402
Practice Address - Fax:801-262-8118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT152864-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4374Medicaid
UT4374Medicaid