Provider Demographics
NPI:1841217353
Name:BAKER, STEPHEN WALTER III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WALTER
Last Name:BAKER
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3437
Mailing Address - Country:US
Mailing Address - Phone:605-665-4757
Mailing Address - Fax:
Practice Address - Street 1:1100 DOUGLAS AVE
Practice Address - Street 2:FPC YANKTON
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3076
Practice Address - Country:US
Practice Address - Phone:605-665-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant