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General NPI Number Information
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NPI Number | 1487120325
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Entity Type | Organization
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Legal Business Name | EDMOND L BAKER JR MD PC
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 926 E MCDOWELL RD STE 134
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City | PHOENIX
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State | AZ
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Zip | 85006-2521
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Country | US
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Telephone | 602-935-6270
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Fax | 602-899-1231
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Provider Business Mailing Address
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Address Line | 743 E WINDSONG DR
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City | PHOENIX
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State | AZ
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Zip | 85048-2069
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Country | US
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Telephone | 602-935-6270
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Fax | 602-899-1231
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDMOND LOWE BAKER JR.
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Credential | MD
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Telephone | 480-280-7588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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