Healthcare Provider Details

I. General information

NPI: 1508893249
Provider Name (Legal Business Name): JOSEPH GOTHILF BAUM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 GULFPORT BLVD S
GULFPORT FL
33707-4947
US

IV. Provider business mailing address

5301 GULFPORT BLVD S
GULFPORT FL
33707-4947
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-9777
  • Fax: 727-202-1010
Mailing address:
  • Phone: 727-894-9777
  • Fax: 727-202-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: