Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0101037372 | VA |
NPI | 1003898040 |
---|---|
Provider Name | Joseph W Baker |
First Address | Roanoke, VA 24014-2462 |
Second Address | Roanoke, VA 24014-2462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 27/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010264375 | (05) | VA |
7364164 | (05) | VA |
E79197 | (02) |