Provider Demographics
NPI:1376516336
Name:BAUGHMAN, CHARLES JON (AT,C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JON
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 N 166TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1464
Mailing Address - Country:US
Mailing Address - Phone:623-293-1604
Mailing Address - Fax:480-668-4545
Practice Address - Street 1:2510 W RIO SALADO PKWY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3603
Practice Address - Country:US
Practice Address - Phone:623-293-1604
Practice Address - Fax:480-668-4545
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1792255A2300X
SD1162255A2300X
IDAT-1862255A2300X
IL096-0020842255A2300X
TN9182255A2300X
AZ202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer