Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3995 | IA |
Y | 207Q00000X | Family Doctor | 3995 | IA |
N | 208D00000X | General Practice Physician | 02003106A | IN |
NPI | 1154547073 |
---|---|
Provider Name | Joshua Paul Baker |
First Address | Rockwell, IA 50469-1035 |
Second Address | Rockwell, IA 50469-1035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 10/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11012682A | RESIDENCY PERMIT (01) | IN |
PENDING | (02) | IN |
PENDING | (05) | IN |