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General NPI Number Information
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NPI Number | 1649350034
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Entity Type | Individual
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Provider Name | BAOAN GIA LE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 4527 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-3702
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Country | US
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Telephone | 602-249-4508
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Fax | 602-249-1614
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Provider Business Mailing Address
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Address Line | 2325 E SHEA BLVD
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City | PHOENIX
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State | AZ
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Zip | 85028-3115
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Country | US
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Telephone | 918-344-0130
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 94404
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23089
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36389
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License Number State | AZ
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