Provider Demographics
NPI:1225086630
Name:BAKER, JAMES (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S 52ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8602
Mailing Address - Country:US
Mailing Address - Phone:479-319-6009
Mailing Address - Fax:479-319-6002
Practice Address - Street 1:808 S 52ND ST STE 201
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8602
Practice Address - Country:US
Practice Address - Phone:479-319-6009
Practice Address - Fax:479-319-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118653003Medicaid
AR54184OtherBLUE
AR54184Medicare ID - Type Unspecified
AR118653003Medicaid