Provider Demographics
NPI:1467707000
Name:BAUMGART, ROY (HIS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:BAUMGART
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14848 N CAVE CREEK RD STE 14
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4954
Mailing Address - Country:US
Mailing Address - Phone:602-992-3520
Mailing Address - Fax:602-923-1104
Practice Address - Street 1:14848 N CAVE CREEK RD STE 14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4954
Practice Address - Country:US
Practice Address - Phone:602-992-3520
Practice Address - Fax:602-923-1104
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD5540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist