Provider Demographics
NPI:1275848475
Name:WILLIAM T. BAKER D.O. P.A.
Entity Type:Organization
Organization Name:WILLIAM T. BAKER D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-522-7313
Mailing Address - Street 1:2020 S SOLANO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5416
Mailing Address - Country:US
Mailing Address - Phone:575-522-7313
Mailing Address - Fax:575-522-7277
Practice Address - Street 1:2020 S SOLANO DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5416
Practice Address - Country:US
Practice Address - Phone:575-522-7313
Practice Address - Fax:575-522-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA709NM207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty