Healthcare Provider Details

I. General information

NPI: 1598076044
Provider Name (Legal Business Name): SUE ELLEN BAUM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 COIT RD SUITE 295
PLANO TX
75075-5041
US

IV. Provider business mailing address

312 ORIOLE DR
MURPHY TX
75094-3889
US

V. Phone/Fax

Practice location:
  • Phone: 972-599-1637
  • Fax:
Mailing address:
  • Phone: 214-293-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberL2795
License Number StateTX

VIII. Authorized Official

Name: DR. SUE ELLEN BAUM
Title or Position: OWNER
Credential: MD
Phone: 214-293-7086