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NPI Code Detail

MEDICARE: BAOAN GIA LE M.D.

MEDICARE: BAOAN GIA LE M.D.
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
1207Q00000XFamily Medicine PhysicianME 94404FL
2207Q00000XFamily Medicine Physician23089OK
3207Q00000XFamily Medicine Physician36389AZ

General Provider Information

NPI Number : 1649350034
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAOAN GIA LE M.D.
Provider Business Mailing Address
First Line : 2325 E SHEA BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-3115
Country : US
Telephone Number : 918-344-0130
Fax Number :
Provider Business Practice Location Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-249-4508
Fax Number : 602-249-1614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 04/15/2008

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Directions to “ BAOAN GIA LE M.D.” Practice Location

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