Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 37240 | AZ |
Y | 207V00000X | Obstetrician & Gynecologist | 37240 | AZ |
N | 207V00000X | Obstetrician & Gynecologist | 81650 | AZ |
NPI | 1235304171 |
---|---|
Provider Name | Dr. Edmond Lowe Baker JR. |
First Address | Phoenix, AZ 85004-4608 |
Second Address | Phoenix, AZ 85015-5124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 07/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
238838 | MASSACHUSETTS LICENSE (01) | MA |
37240 | ARIZONA LICENSE (01) | AZ |
467843 | (05) | AZ |