Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 07806 | LA |
NPI | 1033429824 |
---|---|
Provider Name | Megan Danielle Baker |
First Address | Ruston, LA 71270-5941 |
Second Address | Ruston, LA 71270-5941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2010 |
Last Update Date | 01/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3C175CR78 | MEDICARE (01) | LA |