Healthcare Provider Details

I. General information

NPI: 1407332034
Provider Name (Legal Business Name): HERBERT BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SW 87TH AVE
MIAMI FL
33165-3245
US

IV. Provider business mailing address

3000 SW 87TH AVE
MIAMI FL
33165-3245
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAL131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: