Provider Demographics
NPI:1790903003
Name:DAVID R BAKER
Entity Type:Organization
Organization Name:DAVID R BAKER
Other - Org Name:LOGAN DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-512-8151
Mailing Address - Street 1:55 E 100 N
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4661
Mailing Address - Country:US
Mailing Address - Phone:435-512-8151
Mailing Address - Fax:
Practice Address - Street 1:55 E 100 N
Practice Address - Street 2:SUITE 305
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4661
Practice Address - Country:US
Practice Address - Phone:435-512-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory