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General NPI Number Information
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NPI Number | 1538665187
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Entity Type | Individual
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Provider Name | MARK ENSIO BAKER II
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Gender | Male
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1233 N 30TH ST
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City | BILLINGS
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State | MT
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Zip | 59101-0127
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Country | US
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Telephone | 406-237-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 FOREST PARK RD APT 3216
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City | DALLAS
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State | TX
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Zip | 75235-6424
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Country | US
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Telephone | 817-600-9018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 142250
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License Number State | MT
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