Healthcare Provider Details

I. General information

NPI: 1396797833
Provider Name (Legal Business Name): DOLE P BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 CORNELIA RD
ANDERSON SC
29621-3349
US

IV. Provider business mailing address

PO BOX 139
ANDERSON SC
29622-0139
US

V. Phone/Fax

Practice location:
  • Phone: 864-226-2822
  • Fax: 864-226-2882
Mailing address:
  • Phone: 864-226-2822
  • Fax: 864-226-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18104
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: