Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3594 | AR |
NPI | 1174742456 |
---|---|
Provider Name | Dr. Mark Andrew Baber |
First Address | Rogers, AR 72758-8710 |
Second Address | Rogers, AR 72758-8710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
166330679 | (05) | AR |