Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AL131 | FL |
Y | 213ES0000X | Sports Medicine | AL131 | FL |
NPI | 1407332034 |
---|---|
Provider Name | Herbert Baker |
First Address | Miami, FL 33165-3245 |
Second Address | Miami, FL 33165-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |