Healthcare Provider Details

I. General information

NPI: 1386619468
Provider Name (Legal Business Name): WILLARD ROBERT BAKER JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SAVANNAH AVE SUITE 101A
MCALLEN TX
78503-1241
US

IV. Provider business mailing address

1000 E VERMONT AVE APT. 1103
MCALLEN TX
78503-1717
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-4040
  • Fax: 956-686-2936
Mailing address:
  • Phone: 955-926-5129
  • Fax: 956-686-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: