Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17146 | OH |
NPI | 1063566016 |
---|---|
Provider Name | Dr. Peter L. Baum |
First Address | North Olmsted, OH 44070-3200 |
Second Address | North Olmsted, OH 44070-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |