Healthcare Provider Details

I. General information

NPI: 1881676732
Provider Name (Legal Business Name): JON M BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

PO BOX 4860
MURRELLS INLET SC
29576-2698
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8940
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-491-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number163390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: