Provider Demographics
NPI:1356572101
Name:BABCOCK, STEVEN WAYNE (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 PARKWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:WY
Mailing Address - Zip Code:82939
Mailing Address - Country:US
Mailing Address - Phone:307-782-7560
Mailing Address - Fax:307-782-7584
Practice Address - Street 1:531 PARKWAY DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939
Practice Address - Country:US
Practice Address - Phone:307-782-7560
Practice Address - Fax:307-782-7584
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0644207Q00000X
WY8932A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine