Provider Demographics
NPI:1508805755
Name:BAUM, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:903-531-5000
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058KAOtherBCBS
TX104633606Medicaid
TX104633609Medicaid
TX8EZ027OtherBCBS
TX104633608Medicaid
TX75-2616977-001OtherTRICARE
TX8EZ026OtherBCBS
TX104633605Medicaid
TX75-2616977-028OtherTRICARE
TX750818167-044OtherTRICARE
TX104633603Medicaid
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TXP01470460OtherRAIL ROAD MEDICARE
TXTIN PLUS 005OtherTRICARE
TX75-0818167-048OtherBCBS
TX104633607Medicaid
TXTIN PLUS 015OtherTRICARE
TXTIN PLUS 015OtherTRICARE
TX104633608Medicaid
TX75-2616977-001OtherTRICARE
TXTIN PLUS 005OtherTRICARE
TX0058KAOtherBCBS
TXG31727Medicare UPIN
TX104633606Medicaid
TX402862YMAFMedicare PIN