Provider Demographics
NPI:1447297239
Name:BAUGH, JOHN R JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BAUGH
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 1:2001 MALL DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2560
Mailing Address - Country:US
Mailing Address - Phone:701-364-8000
Mailing Address - Fax:903-949-6039
Practice Address - Street 1:2001 MALL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2560
Practice Address - Country:US
Practice Address - Phone:903-336-3412
Practice Address - Fax:903-949-6039
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10101207P00000X, 207Q00000X
TXK2644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13605Medicaid
ND713407Medicare PIN
ND711634Medicare ID - Type Unspecified
ND13605Medicaid