Healthcare Provider Details

I. General information

NPI: 1619700309
Provider Name (Legal Business Name): DALTON JAMES BAKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6763 PAGE AVE
SAINT LOUIS MO
63133-1635
US

IV. Provider business mailing address

4420 NORFOLK AVE APT 203
SAINT LOUIS MO
63110-2292
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8700
  • Fax: 314-898-1773
Mailing address:
  • Phone: 636-222-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: