Individual provider · NPI-1

Jesse Blake Bauer

Emergency Medicine · Tallahassee, FL

NPI number1871024117
StatusActive
Last updated in NPPESApr 29, 2021

Details

NPI
1871024117
Entity type
Individual (NPI-1)
Name
Jesse Blake Bauer
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 27, 2017
Certification date
Apr 29, 2021
Last updated
Apr 29, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207P00000X Emergency Medicine227135NCYes
207P00000X Emergency MedicineME145248FL
390200000X Student in an Organized Health Care Education/Training Program––

Other names

  • Jesse Blake Cogburn (Former Name)

Practice location

1300 Miccosukee Rd
Tallahassee, FL 32308-5054

Phone 850-431-0911

Mailing address

1607 Saint James Ct Ste 1
Tallahassee, FL 32308-5352

Phone 850-431-7021

Other practice locations

1000 Blythe Blvd
Department Of Emergency Medicine
Charlotte, NC 28203-5812

Phone 704-355-3181 · Fax 704-355-7047

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