Provider Demographics
NPI:1811285968
Name:L. DWIGHT BAKER, M.D., P.C.
Entity type:Organization
Organization Name:L. DWIGHT BAKER, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-3113
Mailing Address - Street 1:105 PROFESSIONAL LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3875
Mailing Address - Country:US
Mailing Address - Phone:334-793-3113
Mailing Address - Fax:334-671-2894
Practice Address - Street 1:105 PROFESSIONAL LN
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3875
Practice Address - Country:US
Practice Address - Phone:334-793-3113
Practice Address - Fax:334-671-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL310632086S0122X
AL83432086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty