Provider Demographics
NPI:1508893249
Name:BAUM, JOSEPH GOTHILF (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GOTHILF
Last Name:BAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4947
Mailing Address - Country:US
Mailing Address - Phone:727-894-9777
Mailing Address - Fax:727-202-1010
Practice Address - Street 1:5301 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4947
Practice Address - Country:US
Practice Address - Phone:727-894-9777
Practice Address - Fax:727-202-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6156253OtherUBH PROVIDER ID#
FL010152OtherVALUEOPTIONS PROVIDER #
FL6156253OtherUBH PROVIDER ID#