Healthcare Provider Details

I. General information

NPI: 1316949985
Provider Name (Legal Business Name): LORI C BAUGHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 GLENN HENDREN DRIVE
LIBERTY MO
64068-4205
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7730
  • Fax: 816-415-1886
Mailing address:
  • Phone: 816-781-7730
  • Fax: 816-415-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD110542
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD110542
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: