Healthcare Provider Details

I. General information

NPI: 1336375484
Provider Name (Legal Business Name): LAWRENCE OWEN BAUM III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 RICHMOND AVE
HOUSTON TX
77027-6856
US

IV. Provider business mailing address

7777 SOUTHWEST FWY SUITE 1032
HOUSTON TX
77074-1802
US

V. Phone/Fax

Practice location:
  • Phone: 713-351-0644
  • Fax: 713-351-0634
Mailing address:
  • Phone: 713-771-9224
  • Fax: 713-771-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberN2935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: