Healthcare Provider Details

I. General information

NPI: 1912562695
Provider Name (Legal Business Name): ANTHONY JASON BAUGH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 BROAD ST
SUMTER SC
29150-1820
US

IV. Provider business mailing address

401 ARNOLD CT
TRAVIS AFB CA
94535-1300
US

V. Phone/Fax

Practice location:
  • Phone: 803-778-6555
  • Fax:
Mailing address:
  • Phone: 210-562-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: