Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 59651 | MN |
NPI | 1366523417 |
---|---|
Provider Name | Justin J Baker |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Saint Paul, MN 55102-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 04/11/2020 |