Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 24234 | MN |
NPI | 1649475807 |
---|---|
Provider Name | Dr. Barry Keith Baines |
First Address | Minneapolis, MN 55405-2466 |
Second Address | Minneapolis, MN 55413-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D99853 | (02) | MN |