Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 56571 | TN |
NPI | 1003270968 |
---|---|
Provider Name | Dr. Brent A Baker |
First Address | Johnson City, TN 37602-3889 |
Second Address | Kingsport, TN 37660-3858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 05/03/2021 |