Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | ME 54830 | FL |
NPI | 1376821678 |
---|---|
Provider Name | Tracy M Baker |
First Address | Miami, FL 33156 |
Second Address | Miami, FL 33156-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 03/08/2011 |