Healthcare Provider Details

I. General information

NPI: 1225207178
Provider Name (Legal Business Name): JAMES W BAKER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9495 SW LOCUST ST STE A
PORTLAND OR
97223-6683
US

IV. Provider business mailing address

9495 SW LOCUST ST STE A
PORTLAND OR
97223-6683
US

V. Phone/Fax

Practice location:
  • Phone: 503-636-9011
  • Fax: 503-636-3952
Mailing address:
  • Phone: 503-636-9011
  • Fax: 503-636-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD08914
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD08914
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD08916
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD08914
License Number StateOR

VIII. Authorized Official

Name: CINDY M MADDEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-505-5937