Healthcare Provider Details

I. General information

NPI: 1013941129
Provider Name (Legal Business Name): STUART EMERSON BAIRD IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS PENNSYLVANIA (SSBN 735) (GOLD)
FPO AE WA
96698-2122
US

IV. Provider business mailing address

USS PENNSYLVANIA (SSBN 735) (GOLD)
FPO AE WA
96698-2122
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4205
  • Fax: 360-396-4247
Mailing address:
  • Phone: 360-315-4205
  • Fax: 360-396-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: