Provider Demographics
NPI:1639615289
Name:BAKER, RONALD J (CRNP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HARLEY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4218
Mailing Address - Country:US
Mailing Address - Phone:256-259-0061
Mailing Address - Fax:256-259-0668
Practice Address - Street 1:507 HARLEY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4218
Practice Address - Country:US
Practice Address - Phone:256-259-0061
Practice Address - Fax:256-259-0668
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine