Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A592-72 | NM |
NPI | 1235261728 |
---|---|
Provider Name | Dr. James Emil Baum |
First Address | Santa Fe, NM 87505-4760 |
Second Address | Santa Fe, NM 87505-4760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2007 |
Last Update Date | 08/07/2007 |