Healthcare Provider Details

I. General information

NPI: 1356386577
Provider Name (Legal Business Name): JOANNE ELAINE BAERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 4660
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

27472 PORTOLA PKWY STE 205
FOOTHILL RANCH CA
92610-2853
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax:
Mailing address:
  • Phone: 909-709-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA73774
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA73774
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberNM2021-0493
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: