Provider Demographics
NPI:1558734988
Name:BAUMANN, JESSICA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 2ND ST
Mailing Address - Street 2:#2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7773
Mailing Address - Country:US
Mailing Address - Phone:814-602-0167
Mailing Address - Fax:
Practice Address - Street 1:210 E 2ND ST
Practice Address - Street 2:#2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7773
Practice Address - Country:US
Practice Address - Phone:814-602-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53425207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology