Provider Demographics
NPI:1750582276
Name:BAKER FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:BAKER FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-537-2700
Mailing Address - Street 1:1321 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531-2605
Mailing Address - Country:US
Mailing Address - Phone:850-537-2700
Mailing Address - Fax:850-537-2702
Practice Address - Street 1:1321 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:FL
Practice Address - Zip Code:32531-2605
Practice Address - Country:US
Practice Address - Phone:850-537-2700
Practice Address - Fax:850-537-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26297OtherBCBS
FL26297AMedicare ID - Type Unspecified
FL26297OtherBCBS