Healthcare Provider Details

I. General information

NPI: 1235261728
Provider Name (Legal Business Name): JAMES EMIL BAUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 OLD PECOS TRL STE L
SANTA FE NM
87505-4760
US

IV. Provider business mailing address

1850 OLD PECOS TRL STE L
SANTA FE NM
87505-4760
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8647
  • Fax: 505-983-6464
Mailing address:
  • Phone: 505-989-8647
  • Fax: 505-983-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA592-72
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: