Healthcare Provider Details

I. General information

NPI: 1194897256
Provider Name (Legal Business Name): DAVID A BAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 COYLE AVENUE SUITE 416
CARMICHAEL CA
95608-0310
US

IV. Provider business mailing address

1010 HURLEY WAY SUITE 500
SACRAMENTO CA
95825-3216
US

V. Phone/Fax

Practice location:
  • Phone: 916-966-3501
  • Fax: 916-966-2805
Mailing address:
  • Phone: 916-564-3040
  • Fax: 916-564-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG28673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG28673
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG28673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: