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General NPI Number Information
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NPI Number | 1568633543
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Entity Type | Organization
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Legal Business Name | MICHAEL L BAKER DO PA
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 129 S MAIN ST
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City | YAZOO CITY
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State | MS
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Zip | 39194-4007
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Country | US
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Telephone | 662-746-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 129 S. MAIN STREET
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City | YAZOO CITY
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State | MS
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Zip | 39194
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Country | US
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Telephone | 662-746-8777
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Fax | 662-746-8778
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MICHAEL LEO BAKER
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Credential | D.O.
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Telephone | 662-746-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15475
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License Number State | MS
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