Provider Demographics
NPI:1659469773
Name:YVONNE BAUM M.D., P.A.
Entity Type:Organization
Organization Name:YVONNE BAUM M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-596-3808
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:SUITE 912
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-596-3808
Mailing Address - Fax:903-561-0836
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 912
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-596-3808
Practice Address - Fax:903-561-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078MGOtherBCBS GROUP
TX171295201Medicaid
TX171295201Medicaid