Provider Demographics
NPI:1134237761
Name:BAUMGARTNER, FRITZ J (MD)
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:J
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 KATELLA AVE #201
Mailing Address - Street 2:VASCULAR AND GENERAL SURGERY ASSOC
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-596-5387
Practice Address - Street 1:3791 KATELLA AVE #201
Practice Address - Street 2:VASCULAR AND GENERAL SURGERY ASSOC
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-596-5387
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55475208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554750Medicaid
CACA835ZMedicare PIN
CACA835YMedicare PIN
F08296Medicare UPIN
CA00G554750Medicaid