MEDICARE: HUNTER BAUM RD, RDN

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	133VN1501X	Sports Dietetics Nutrition Registered Dietitian	13650339-4901	UT

General Provider Information

NPI Number	:	1417769290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER BAUM RD, RDN

Provider Business Mailing Address
First Line	:	1177 E 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1946
Country	:	US
Telephone Number	:	267-373-8856
Fax Number	:

Provider Business Practice Location Address
First Line	:	1177 E 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1946
Country	:	US
Telephone Number	:	267-373-8856
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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