Provider Demographics
NPI:1194897256
Name:BAYNE, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BAYNE
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 1:1010 HURLEY WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3216
Mailing Address - Country:US
Mailing Address - Phone:916-564-3040
Mailing Address - Fax:916-564-3065
Practice Address - Street 1:6401 COYLE AVENUE
Practice Address - Street 2:SUITE 416
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0310
Practice Address - Country:US
Practice Address - Phone:916-966-3501
Practice Address - Fax:916-966-2805
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28673207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060034073OtherRAILROAD MEDICARE
CAGR0068235Medicaid
CAGR006823BMedicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47676ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068232Medicaid
CAGR0068233Medicaid
CAGR0068230Medicaid
CAGR0068231Medicaid
CAZZZ47674ZOtherBLUE SHIELD
CA00G286730Medicaid
CAZZZ00968ZMedicare PIN
CAZZZZ00967ZMedicare PIN
CAGR006823BMedicaid
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068233Medicaid
CAGR0068232Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47674ZOtherBLUE SHIELD