Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME136774 | FL |
NPI | 1568445872 |
---|---|
Provider Name | Mark Douglas Baker |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 17/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352281401 | (05) | MD |
PENDING | (05) | FL |