Provider Demographics
NPI:1740804848
Name:JOSEPH BAKER, DIEDRA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:DIEDRA
Middle Name:MICHELLE
Last Name:JOSEPH BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-7739
Mailing Address - Country:US
Mailing Address - Phone:334-874-3463
Mailing Address - Fax:
Practice Address - Street 1:1023 MEDICAL CENTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-7739
Practice Address - Country:US
Practice Address - Phone:334-874-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program