Provider Demographics
NPI:1093895393
Name:BAKER, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:BAKER
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 1:10810 PARKSIDE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1983
Mailing Address - Country:US
Mailing Address - Phone:865-392-9220
Mailing Address - Fax:865-392-9221
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE G12
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-392-9220
Practice Address - Fax:865-392-9221
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019699208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3044774Medicaid
TN0098199OtherBLUE CROSS BLUE SHIELD
TNE07088Medicare UPIN
TN3044774Medicare ID - Type Unspecified