Provider Demographics
NPI:1235129552
Name:BAKER, DAVID LITTLETON JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LITTLETON
Last Name:BAKER
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 1:810 MERRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4436
Mailing Address - Country:US
Mailing Address - Phone:501-329-3937
Mailing Address - Fax:501-932-7663
Practice Address - Street 1:810 MERRIMAN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4436
Practice Address - Country:US
Practice Address - Phone:501-329-3937
Practice Address - Fax:501-932-7663
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7453207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125284001Medicaid
AR125284001Medicaid
AR5J400Medicare ID - Type Unspecified