Healthcare Provider Details

I. General information

NPI: 1891741484
Provider Name (Legal Business Name): MICHAEL BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WETUMPKA AL
36092-1625
US

IV. Provider business mailing address

6000 OTTER POINT RD
PENSACOLA FL
32504-7954
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-4311
  • Fax:
Mailing address:
  • Phone: 205-835-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8528
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: