Provider Demographics
NPI:1205847654
Name:BAUM, BRADLEY LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LLOYD
Last Name:BAUM
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 1:341 MAGNOLIA AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3331
Mailing Address - Country:US
Mailing Address - Phone:951-735-6060
Mailing Address - Fax:951-735-4510
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:STE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3331
Practice Address - Country:US
Practice Address - Phone:951-735-6060
Practice Address - Fax:951-735-4510
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G511970OtherBLUE SHIELD
CA00G511970Medicaid
200034607OtherRR MEDICARE
CA00G511970OtherBLUE CROSS
CA00G511970OtherBLUE CROSS
CA00G511970Medicaid