Provider Demographics
NPI:1063408326
Name:BAUMERT, PAUL W JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:BAUMERT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HICKMAN RD
Mailing Address - Street 2:BROADLAWNS MEDICAL CENTER
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1505
Mailing Address - Country:US
Mailing Address - Phone:515-282-2501
Mailing Address - Fax:515-282-2502
Practice Address - Street 1:3500 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8676
Practice Address - Country:US
Practice Address - Phone:515-239-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26867207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19482OtherWELLMARK BCBS
IA0439869Medicaid
IA1063408326Medicaid
IA1063408326Medicaid
IA0439869Medicaid