Healthcare Provider Details

I. General information

NPI: 1275848475
Provider Name (Legal Business Name): WILLIAM T. BAKER D.O. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S SOLANO DR SUITE A
LAS CRUCES NM
88001-5416
US

IV. Provider business mailing address

2020 S SOLANO DR SUITE A
LAS CRUCES NM
88001-5416
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7313
  • Fax: 575-522-7277
Mailing address:
  • Phone: 575-522-7313
  • Fax: 575-522-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA709NM
License Number StateNM

VIII. Authorized Official

Name: MS. SUSAN BROWN BAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-522-7313