Healthcare Provider Details

I. General information

NPI: 1477133445
Provider Name (Legal Business Name): CHARLES BAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 107
UKIAH CA
95482-4568
US

IV. Provider business mailing address

260 HOSPITAL DR ST 107
UKIAH CA
95482-4561
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-5278
  • Fax:
Mailing address:
  • Phone: 707-467-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA192107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: