Provider Demographics
NPI:1801880240
Name:BAUMANN, JAMES DARYL (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DARYL
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 E BROWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8007
Mailing Address - Country:US
Mailing Address - Phone:480-981-5995
Mailing Address - Fax:480-807-4211
Practice Address - Street 1:4855 E BROWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8007
Practice Address - Country:US
Practice Address - Phone:480-981-5995
Practice Address - Fax:480-807-4211
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-12-18
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
AZ1868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDO1868Medicare PIN