Healthcare Provider Details

I. General information

NPI: 1538121025
Provider Name (Legal Business Name): JOSEPH BAUMSTARCK JR. M.D.1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 E MAIN ST
LOVELL WY
82431-2136
US

IV. Provider business mailing address

342 E MAIN ST
LOVELL WY
82431-2136
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7092
  • Fax: 307-548-6910
Mailing address:
  • Phone: 307-548-7092
  • Fax: 307-548-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5460A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: