Healthcare Provider Details

I. General information

NPI: 1588620421
Provider Name (Legal Business Name): ERIC BAUMANN MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CENTERPOINTE WEST DR
PRESCOTT AZ
86301-8487
US

IV. Provider business mailing address

2100 CENTERPOINTE WEST DR
PRESCOTT AZ
86301-8487
US

V. Phone/Fax

Practice location:
  • Phone: 928-717-0788
  • Fax: 928-717-0748
Mailing address:
  • Phone: 928-717-0788
  • Fax: 928-717-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34059
License Number StateAZ

VIII. Authorized Official

Name: MARGIE ANACAYA
Title or Position: PRACTICE ADMINISTRATOR
Credential: MD
Phone: 928-717-0788