Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 28097 | TN |
NPI | 1003801796 |
---|---|
Provider Name | John Baker |
First Address | Jackson, TN 38302-0400 |
Second Address | Jackson, TN 38301-3937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 29/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1505760 | (05) | TN |
3807824 | (05) | TN |
F34002 | (02) | TN |