Healthcare Provider Details

I. General information

NPI: 1326330887
Provider Name (Legal Business Name): BIRON D. BAKER FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 COLEMAN ST STE 107
BISMARCK ND
58503-1371
US

IV. Provider business mailing address

4401 COLEMAN ST STE 107
BISMARCK ND
58503-1371
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-4390
  • Fax: 701-751-4332
Mailing address:
  • Phone: 701-751-4340
  • Fax: 701-751-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7534
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR29280
License Number StateND

VIII. Authorized Official

Name: RONALD J PIATZ
Title or Position: OFFICE MANAGER
Credential: MT
Phone: 701-751-4340