Provider Demographics
NPI:1942596481
Name:BAKER, DAVID WILLIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIS
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 S WM HOOKER DR
Practice Address - Street 2:
Practice Address - City:HOOKERTON
Practice Address - State:NC
Practice Address - Zip Code:28538-7188
Practice Address - Country:US
Practice Address - Phone:252-747-2089
Practice Address - Fax:252-747-2734
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201201747208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCA606CMedicare PIN