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General NPI Number Information
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NPI Number | 1154055176
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Entity Type | Individual
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Provider Name | ANDREW DALE BAUM DPM
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Gender | Male
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 710 SUNSET DR STE F
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City | LA GRANDE
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State | OR
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Zip | 97850-1200
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Country | US
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Telephone | 541-663-3100
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Fax | 541-975-5135
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Provider Business Mailing Address
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Address Line | PO BOX 3290
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City | LA GRANDE
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State | OR
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Zip | 97850-7290
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Country | US
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Telephone | 541-963-8421
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Fax | 541-963-1476
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | EL7071
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP224419
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License Number State | OR
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