Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 8343 | AL |
NPI | 1114062106 |
---|---|
Provider Name | Dr. Luther Dwight Baker |
First Address | Dothan, AL 36303-3875 |
Second Address | Dothan, AL 36303-3875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C70578 | (02) | AL |