Provider Demographics
NPI:1972837615
Name:JOHN W. BAKER, MD, PA
Entity Type:Organization
Organization Name:JOHN W. BAKER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-812-7216
Mailing Address - Street 1:1 LILE CT STE 103
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6239
Mailing Address - Country:US
Mailing Address - Phone:501-221-9175
Mailing Address - Fax:501-221-9672
Practice Address - Street 1:1 LILE CT STE 103
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6239
Practice Address - Country:US
Practice Address - Phone:501-221-9175
Practice Address - Fax:501-221-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4060208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR-4090OtherLICENSE