Healthcare Provider Details

I. General information

NPI: 1366076473
Provider Name (Legal Business Name): JOSHUA DAVID BAKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSH BAKER PA-C

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

IV. Provider business mailing address

617 NORTHMOOR LN
BIRMINGHAM AL
35209-6421
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax:
Mailing address:
  • Phone: 770-842-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: