Provider Demographics
NPI:1962452615
Name:BAUM, ALEX E (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:E
Last Name:BAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8000 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1754
Mailing Address - Country:US
Mailing Address - Phone:901-747-3630
Mailing Address - Fax:901-747-0052
Practice Address - Street 1:8000 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1754
Practice Address - Country:US
Practice Address - Phone:901-747-3630
Practice Address - Fax:901-747-0052
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN40889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1498637Medicaid
LA1498637Medicaid
LA5E534Medicare ID - Type Unspecified