Healthcare Provider Details

I. General information

NPI: 1205002680
Provider Name (Legal Business Name): DAVID WAYNE BAKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 BERRYWOOD DR 200
COLUMBIA MO
65201-6500
US

IV. Provider business mailing address

3407 BERRYWOOD DR 200
COLUMBIA MO
65201-6500
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-1177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2007033943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: