Healthcare Provider Details

I. General information

NPI: 1205987666
Provider Name (Legal Business Name): JOHN C. BAKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 MILTON BLVD
NEWTON FALLS OH
44444-9793
US

IV. Provider business mailing address

1978 MILTON BLVD
NEWTON FALLS OH
44444-9793
US

V. Phone/Fax

Practice location:
  • Phone: 330-872-1336
  • Fax:
Mailing address:
  • Phone: 330-872-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-003006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: