Healthcare Provider Details

I. General information

NPI: 1801874698
Provider Name (Legal Business Name): TODD F BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NORTH MAIN
HARRISON AR
72601-2926
US

IV. Provider business mailing address

PO BOX 32600
SHREVEPORT LA
71130-2600
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-2000
  • Fax: 318-212-7505
Mailing address:
  • Phone: 318-212-4877
  • Fax: 318-212-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15526R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-3581
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: