Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC13277 | CA |
NPI | 1861507204 |
---|---|
Provider Name | Dr. Donald Jerry Baune |
First Address | Lomita, CA 90717-2125 |
Second Address | Lomita, CA 90717-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205166675 | GROUP NPI (01) | CA |
CV133A | GROUP PTAN (01) | CA |
CV134Z | INDIVIDUAL PTAN (01) | CA |
DC13277 | CHIROPRACTIC LICENSE (01) | CA |