Healthcare Provider Details

I. General information

NPI: 1467707000
Provider Name (Legal Business Name): ROY BAUMGART H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14848 N CAVE CREEK RD STE 14
PHOENIX AZ
85032-4954
US

IV. Provider business mailing address

14848 N CAVE CREEK RD STE 14
PHOENIX AZ
85032-4954
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-3520
  • Fax: 602-923-1104
Mailing address:
  • Phone: 602-992-3520
  • Fax: 602-923-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHAD5540
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: