Provider Demographics
NPI:1497929863
Name:BAUGHMAN & ASSOCIATES AGE MANAGEMENT MEDICINE LLC
Entity Type:Organization
Organization Name:BAUGHMAN & ASSOCIATES AGE MANAGEMENT MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-977-0955
Mailing Address - Street 1:13460 N 94TH DR
Mailing Address - Street 2:STE L1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4835
Mailing Address - Country:US
Mailing Address - Phone:623-977-0955
Mailing Address - Fax:623-977-3729
Practice Address - Street 1:13460 N 94TH DR
Practice Address - Street 2:STE L1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4835
Practice Address - Country:US
Practice Address - Phone:623-977-0955
Practice Address - Fax:623-977-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty