Provider Demographics
NPI:1922457647
Name:JAMES B BAKER DO PA
Entity Type:Organization
Organization Name:JAMES B BAKER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-319-6009
Mailing Address - Street 1:808 S 52ND ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8602
Mailing Address - Country:US
Mailing Address - Phone:479-319-6009
Mailing Address - Fax:479-319-6002
Practice Address - Street 1:808 S 52ND ST
Practice Address - Street 2:SUITE #201
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8602
Practice Address - Country:US
Practice Address - Phone:479-319-6009
Practice Address - Fax:479-319-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8006261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119496744OtherPROVIDER NPI1
AR272062YVDLMedicare UPIN