Provider Demographics
NPI:1538121025
Name:BAUMSTARCK, JOSEPH JR (MD1)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BAUMSTARCK
Suffix:JR
Gender:M
Credentials:MD1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-2136
Mailing Address - Country:US
Mailing Address - Phone:307-548-7092
Mailing Address - Fax:307-548-6910
Practice Address - Street 1:342 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-2136
Practice Address - Country:US
Practice Address - Phone:307-548-7092
Practice Address - Fax:307-548-6910
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5460A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYF16971Medicare UPIN
WY306630Medicare ID - Type Unspecified