Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 59655 | MN |
NPI | 1053739359 |
---|---|
Provider Name | Jesson Baumgartner |
First Address | Reno, NV 89503-4538 |
Second Address | Reno, NV 89503-4538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 04/08/2021 |