Provider Demographics
NPI:1326034836
Name:BAKER, CLARK D III (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:D
Last Name:BAKER
Suffix:III
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:PO BOX 11407
Mailing Address - Street 2:LOCKBOX 1061
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1061
Mailing Address - Country:US
Mailing Address - Phone:205-437-6098
Mailing Address - Fax:205-437-5998
Practice Address - Street 1:2805 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1448
Practice Address - Country:US
Practice Address - Phone:205-814-2104
Practice Address - Fax:205-814-2145
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21072207RC0000X, 207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051522553OtherBCBS
AL051522553Medicaid
AL051540582OtherBCBS
AL051540582OtherBCBS
G85004Medicare UPIN
AL051558813Medicare PIN