Provider Demographics
NPI:1447239116
Name:BAKER, JOHN WILDER (M D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILDER
Last Name:BAKER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 LAKESHORE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2461
Mailing Address - Country:US
Mailing Address - Phone:501-247-4887
Mailing Address - Fax:504-541-9201
Practice Address - Street 1:7300 LAKESHORE DR APT 4
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2461
Practice Address - Country:US
Practice Address - Phone:501-247-4887
Practice Address - Fax:504-541-9201
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311310208600000X
ARR4090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53892OtherBLUE CROSS BLUE SHIELD
AR117587001Medicaid
AR117587001Medicaid