Provider Demographics
NPI:1033215090
Name:ERIC W BAUM MD PC
Entity Type:Organization
Organization Name:ERIC W BAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:256-543-2380
Mailing Address - Street 1:101 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5234
Mailing Address - Country:US
Mailing Address - Phone:256-543-2380
Mailing Address - Fax:256-543-2389
Practice Address - Street 1:101 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5234
Practice Address - Country:US
Practice Address - Phone:256-543-2380
Practice Address - Fax:256-543-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207N00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51010631OtherPROVIDER # FOR BCBS
ALC71831Medicare UPIN