MEDICARE: JAMES ELWOOD BAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G1852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356365324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ELWOOD BAKER MD

Provider Business Mailing Address
First Line	:	3251 INTERSTATE 45 N
Second Line	:	SUITE 100
City	:	CONROE
State	:	TX
Zip	:	77304-2180
Country	:	US
Telephone Number	:	936-582-5642
Fax Number	:	936-788-8181

Provider Business Practice Location Address
First Line	:	3251 INTERSTATE 45 N
Second Line	:	SUITE 100
City	:	CONROE
State	:	TX
Zip	:	77304-2180
Country	:	US
Telephone Number	:	936-582-5642
Fax Number	:	936-788-8181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/17/2011

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