Provider Demographics
NPI:1720196066
Name:BAUM, GEOFFREY E (DO)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:E
Last Name:BAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:GEOFFREY
Other - Middle Name:E
Other - Last Name:BAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6564 SE LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2237
Mailing Address - Country:US
Mailing Address - Phone:503-477-4343
Mailing Address - Fax:866-825-9040
Practice Address - Street 1:6564 SE LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2237
Practice Address - Country:US
Practice Address - Phone:503-477-4343
Practice Address - Fax:866-825-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13935207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271619Medicaid
840495001OtherBX
OR271619Medicaid
ORR0000LGBMRMedicare PIN