Healthcare Provider Details

I. General information

NPI: 1093779316
Provider Name (Legal Business Name): DAVID ROBERT BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 MEDICAL PL
SEYMOUR IN
47274-2640
US

IV. Provider business mailing address

1124 MEDICAL PL
SEYMOUR IN
47274-2640
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-1613
  • Fax: 812-522-6694
Mailing address:
  • Phone: 812-522-1613
  • Fax: 812-522-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01052413A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: