Provider Demographics
NPI:1588966519
Name:BAUMGARTNER, ERIC TAYLOR (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:TAYLOR
Last Name:BAUMGARTNER
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-0307
Mailing Address - Country:US
Mailing Address - Phone:504-813-3688
Mailing Address - Fax:
Practice Address - Street 1:75166 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-2958
Practice Address - Country:US
Practice Address - Phone:985-892-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 0161562083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine