Provider Demographics
NPI:1831537570
Name:BAALMAN, JACOB LEE (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:LEE
Last Name:BAALMAN
Suffix:
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 1:94 BLUE NILE LN
Mailing Address - Street 2:
Mailing Address - City:BLUE EYE
Mailing Address - State:MO
Mailing Address - Zip Code:65611-7384
Mailing Address - Country:US
Mailing Address - Phone:316-641-0561
Mailing Address - Fax:
Practice Address - Street 1:94 BLUE NILE LN
Practice Address - Street 2:
Practice Address - City:BLUE EYE
Practice Address - State:MO
Practice Address - Zip Code:65611-7384
Practice Address - Country:US
Practice Address - Phone:316-641-0561
Practice Address - Fax:252-744-4125
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013813207P00000X
ARE-9898207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine