Provider Demographics
NPI:1356386577
Name:BAERG, JOANNE ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:ELAINE
Last Name:BAERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27472 PORTOLA PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2853
Mailing Address - Country:US
Mailing Address - Phone:909-709-1940
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 4660
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4924
Practice Address - Country:US
Practice Address - Phone:505-563-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73774208600000X, 2086S0120X
NMNM2021-04932086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A737740Medicaid
NMMD2021-0493OtherNM LICENSE
CA00A737740Medicaid