Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 56346 | AZ |
N | 207SG0201X | Clinical Genetics (M.D.) | G77284 | CA |
N | 208000000X | Pediatrician | 56346 | AZ |
NPI | 1659459444 |
---|---|
Provider Name | John C. Baker |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 31/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G772840 | (05) | CA |
A72791 | (02) |