Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 13559 | NV |
NPI | 1003016809 |
---|---|
Provider Name | Dr. Zachary Tyler Baumgardner |
First Address | Reno, NV 89503-4456 |
Second Address | Reno, NV 89503-4456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 07/07/2011 |