Provider Demographics
NPI:1144378217
Name:BAUMBACHER, GORDON DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:DAVID
Last Name:BAUMBACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 COLLEGE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2532
Mailing Address - Country:US
Mailing Address - Phone:415-924-3840
Mailing Address - Fax:415-924-3841
Practice Address - Street 1:810 COLLEGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-2532
Practice Address - Country:US
Practice Address - Phone:415-924-3840
Practice Address - Fax:415-924-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG209512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry