Provider Demographics
NPI:1962401687
Name:BARON, DAVID BRET (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRET
Last Name:BARON
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 1:22601 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5856
Mailing Address - Country:US
Mailing Address - Phone:310-456-6505
Mailing Address - Fax:310-456-8105
Practice Address - Street 1:22601 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5856
Practice Address - Country:US
Practice Address - Phone:310-456-6505
Practice Address - Fax:310-456-8105
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-11-26
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CAG67527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64086ZOtherBLUE SHIELD NUMBER
CA00G675270OtherBLUE CROSS NUMBER
CAZZZ64086ZOtherBLUE SHIELD NUMBER
CAW17311Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
CAWG67527DMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE