Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101248865 | VA |
NPI | 1013069699 |
---|---|
Provider Name | Dr. Robert Caton Baker |
First Address | Bentonville, AR 72712-3988 |
Second Address | Bentonville, AR 72712-3988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165025001 | (05) | AR |