Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K5802 | TX |
NPI | 1003805706 |
---|---|
Provider Name | Dr. Joane Baumer |
First Address | Dallas, TX 75391-1294 |
Second Address | Fort Worth, TX 76104-4917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E69066 | (02) | TX |