Healthcare Provider Details

I. General information

NPI: 1457513202
Provider Name (Legal Business Name): DONALD EARL BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHADWICK DR SUITE 150A
JACKSON MS
39204-3463
US

IV. Provider business mailing address

1860 CHADWICK DR SUITE 150A
JACKSON MS
39204-3463
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2818
  • Fax: 601-376-2813
Mailing address:
  • Phone: 601-376-2818
  • Fax: 601-376-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32296
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number23455
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: