Brandon Baumgarten
Individual provider Active NPI Specialist · Hazelwood, MO
NPI 1003260449 · NPPES record last updated Apr 22, 2016
Key facts
- NPI
- 1003260449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 2013032834 (MO)
- Practice address
- 7299 Town and Country PL
Hazelwood, MO 63042-1929 - Phone
- (219) 629-0982
- NPI assigned
- Apr 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013032834 | MO | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 2013032834 | MO | Yes |
Addresses
Primary practice location
7299 Town and Country PL
Hazelwood, MO 63042-1929
Mailing address
7299 Town and Country PL
Hazelwood, MO 63042-1929
Phone (219) 629-0982
Other providers in Hazelwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.