Healthcare Provider Details

I. General information

NPI: 1144279654
Provider Name (Legal Business Name): ALLYSON BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MONTCLAIR RD SUITE 200
BIRMINGHAM AL
35213-1211
US

IV. Provider business mailing address

924 MONTCLAIR RD SUITE 200
BIRMINGHAM AL
35213-1211
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-7999
  • Fax: 205-591-5051
Mailing address:
  • Phone: 205-591-7999
  • Fax: 205-591-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number24402
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: