Provider Demographics
NPI:1346212339
Name:BAKER, AMERY D (PAC)
Entity Type:Individual
Prefix:
First Name:AMERY
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMERY
Other - Middle Name:D
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 6060
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-838-4211
Mailing Address - Fax:509-838-6432
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 6060
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-4211
Practice Address - Fax:509-838-6432
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086887Medicaid
WA7086887Medicaid