Provider Demographics
NPI:1922206697
Name:BAUGHMAN, GARY SPARKS (LAC, MAOM)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:SPARKS
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 NW HOYT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1225
Mailing Address - Country:US
Mailing Address - Phone:503-709-6026
Mailing Address - Fax:503-224-5024
Practice Address - Street 1:3531 NE 15TH AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2377
Practice Address - Country:US
Practice Address - Phone:503-927-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR41174171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist