Provider Demographics
NPI:1528005766
Name:DUDLEY D BAKER IV AND MARLON D WHITE MD PA.
Entity Type:Organization
Organization Name:DUDLEY D BAKER IV AND MARLON D WHITE MD PA.
Other - Org Name:NORTHWEST WOMENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:IV
Authorized Official - Credentials:M D
Authorized Official - Phone:281-444-3440
Mailing Address - Street 1:13215 DOTSON RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4301
Mailing Address - Country:US
Mailing Address - Phone:281-444-3440
Mailing Address - Fax:281-444-4080
Practice Address - Street 1:13215 DOTSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4301
Practice Address - Country:US
Practice Address - Phone:281-444-3440
Practice Address - Fax:281-444-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093883901Medicaid
TX093883901Medicaid