Healthcare Provider Details

I. General information

NPI: 1356324586
Provider Name (Legal Business Name): TIMOTHY DARRELL BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 FRANKLIN ST SE STE 200
HUNTSVILLE AL
35801-4537
US

IV. Provider business mailing address

2006 FRANKLIN ST SE STE 200
HUNTSVILLE AL
35801-4537
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-0457
  • Fax: 256-539-5827
Mailing address:
  • Phone: 256-539-0457
  • Fax: 256-539-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number55138
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17077
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-3516
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25963
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: