Healthcare Provider Details

I. General information

NPI: 1780891069
Provider Name (Legal Business Name): JAIMISON W BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BERNARD DR SUITE 201
ROANOKE VA
24018-4357
US

IV. Provider business mailing address

5115 BERNARD DR SUITE 201
ROANOKE VA
24018-4357
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-0289
  • Fax: 540-345-9569
Mailing address:
  • Phone: 540-345-0289
  • Fax: 540-345-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101242651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: