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General NPI Number Information
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NPI Number | 1194926626
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Entity Type | Organization
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Legal Business Name | ST JOHNS CARDIOVASCULAR PA
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 300 HEALTH PARK BLVD STE 1000
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3707
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Country | US
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Telephone | 904-810-1045
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Fax | 904-810-1046
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Provider Business Mailing Address
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Address Line | PO BOX 348
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-0348
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Country | US
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Telephone | 904-810-1045
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Fax | 904-810-1046
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD A BAKER
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Credential | MD
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Telephone | 904-810-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME45744
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License Number State | FL
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