MEDICARE: JOEL BAUMGARTNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	A121105	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A121105	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1679629257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL BAUMGARTNER MD

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WEST ARBOR DRIVE, MAIL CODE: 8220
Second Line	:	UC SAN DIEGO MEDICAL CENTER
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1911
Country	:	US
Telephone Number	:	619-543-6711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/09/2017

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