Basic Information
| Provider Information | |||||||||
| NPI: | 1528004496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMGARTL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1541 WINDHAVEN CIR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891171532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105936195 | ||||||||
| FaxNumber: | 5107515338 | ||||||||
| Practice Location | |||||||||
| Address1: | 5395 RUFFIN RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585713630 | ||||||||
| FaxNumber: | 8582953948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | G067802 | CA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | G67802 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | G067802 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 13914 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207N00000X | G067802 | CA | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 00G678020 | 01 | CA | BS OF CA | OTHER |