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General NPI Number Information
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NPI Number | 1487956538
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Entity Type | Organization
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Legal Business Name | BAKER SURAJ, INC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 602 N. LEWIS AVE. SUITE 100
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City | NEW IBERIA
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State | LA
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Zip | 70563
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Country | US
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Telephone | 337-364-2822
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Fax | 337-364-1978
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Provider Business Mailing Address
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Address Line | 602 N. LEWIS AVE. SUITE 100
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City | NEW IBERIA
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State | LA
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Zip | 70563
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Country | US
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Telephone | 337-364-2822
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Fax | 337-364-1978
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Authorized Official
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Title or Position | PHYSICIAN/MEDICAL DIRECTOR
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Name | VINA S. BAKER
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Credential |
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Telephone | 337-364-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 023492
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License Number State | LA
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