Provider Demographics
NPI:1679572614
Name:BAUM, YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:BAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:SUITE 912
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-596-3808
Mailing Address - Fax:903-596-3815
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:SUITE 912
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-596-3808
Practice Address - Fax:903-561-0836
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
TXJ6823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R8720OtherBCBS IND NUMBER
TX039793702Medicaid
TX8D1225Medicare ID - Type Unspecified
TX039793702Medicaid