MEDICARE: GREGORY BAIMA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	001308	IA
2	103TC1900X	Counseling Psychologist	37135	TX

General Provider Information

NPI Number	:	1154332039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BAIMA PHD

Provider Business Mailing Address
First Line	:	1618 TRUEMPER ST RM 119
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILFORD HALL LOOP
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5638
Country	:	US
Telephone Number	:	210-671-4490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/25/2021

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