Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-001616L | PA |
NPI | 1265472153 |
---|---|
Provider Name | Dr. Jimmie Philip Baughman |
First Address | Greensburg, PA 15601-3508 |
Second Address | Greensburg, PA 15601-3508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |