Healthcare Provider Details

I. General information

NPI: 1013829712
Provider Name (Legal Business Name): MR. BENJAMIN P BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BAYOU BLVD STE 34
PENSACOLA FL
32503-2682
US

IV. Provider business mailing address

4400 BAYOU BLVD STE 34
PENSACOLA FL
32503-2682
US

V. Phone/Fax

Practice location:
  • Phone: 850-760-2300
  • Fax:
Mailing address:
  • Phone: 850-760-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: