Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12640 | MS |
NPI | 1013011303 |
---|---|
Provider Name | Dr. Stephen W Baker |
First Address | Gulfport, MS 39503-2637 |
Second Address | Gulfport, MS 39503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012038 | (05) | MS |
12640 | STATE LICENSE (01) | MS |
E69046 | (02) |