Provider Demographics
NPI:1265653745
Name:BAKER, BRITTANY WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:WILSON
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ANNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 14510
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-4510
Mailing Address - Country:US
Mailing Address - Phone:307-734-1800
Mailing Address - Fax:307-734-5012
Practice Address - Street 1:984 W BROADWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-0000
Practice Address - Country:US
Practice Address - Phone:307-734-1800
Practice Address - Fax:307-734-5012
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104743207N00000X
WY7978A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology