Individual
JESSE BLAKE BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1300 MICCOSUKEE RD, TALLAHASSEE, FL 32308-5054
(850) 431-0911
Mailing address
1607 SAINT JAMES CT STE 1, TALLAHASSEE, FL 32308-5352
(850) 431-7021
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
227135
NC
207P00000X
Emergency Medicine Physician
ME145248
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/27/2017
Last updated
04/29/2021
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