Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 26867 | IA |
N | 207QS0010X | Family Doctor - Sports Medicine | 26867 | IA |
NPI | 1063408326 |
---|---|
Provider Name | Paul W Baumert JR. |
First Address | Des Moines, IA 50314-1505 |
Second Address | Ames, IA 50010-8676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0439869 | (05) | IA |
1063408326 | (05) | IA |
19482 | WELLMARK BCBS (01) | IA |
F30231 | (02) |