Provider Demographics
NPI:1427016179
Name:BABSON, JOHN HURST (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HURST
Last Name:BABSON
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 TUMBLEWEED DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1014
Mailing Address - Country:US
Mailing Address - Phone:307-635-1468
Mailing Address - Fax:307-632-5268
Practice Address - Street 1:1331 PRAIRIE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4867
Practice Address - Country:US
Practice Address - Phone:307-632-0728
Practice Address - Fax:307-632-5268
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY00359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115910100Medicaid
010064443OtherRAILROAD MEDICARE
WY558596951001OtherWORKERS COMPENSATION
308553Medicare ID - Type Unspecified
WY115910100Medicaid