Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3615 | TX |
NPI | 1235320417 |
---|---|
Provider Name | Dr. David Scott Baker |
First Address | Rogers, AR 72758-8710 |
Second Address | Rogers, AR 72758-8710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4651577653 | MYUTMB 4651577653 (01) |