Healthcare Provider Details

I. General information

NPI: 1679629257
Provider Name (Legal Business Name): JOEL BAUMGARTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DRIVE, MAIL CODE: 8220 UC SAN DIEGO MEDICAL CENTER
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA121105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: