Provider Demographics
NPI:1093004202
Name:BAUM, KERRY ROBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ROBERT
Last Name:BAUM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 W 300 N
Mailing Address - Street 2:UINTAH BASIN MEDICAL CENTER
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066
Mailing Address - Country:US
Mailing Address - Phone:435-722-4691
Mailing Address - Fax:435-722-6103
Practice Address - Street 1:250 W 300 N
Practice Address - Street 2:UINTAH BASIN MEDICAL CENTER
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066
Practice Address - Country:US
Practice Address - Phone:435-722-4691
Practice Address - Fax:435-722-6103
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT8414666-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery