Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12010697 | IN |
Y | 213EG0000X | General Practice | 12010697 | IN |
NPI | 1003924564 |
---|---|
Provider Name | Dr. Mary C Baker |
First Address | Syracuse, IN 46567 |
Second Address | Syracuse, IN 46567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 08/07/2007 |