Healthcare Provider Details

I. General information

NPI: 1003495961
Provider Name (Legal Business Name): JAMES ROBERT BAUMAN IV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LAKE ST
KENAI AK
99611-6937
US

IV. Provider business mailing address

250 HOSPITAL PL
SOLDOTNA AK
99669-6999
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4111
  • Fax: 844-412-3852
Mailing address:
  • Phone: 907-714-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number220711
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: