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General NPI Number Information
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NPI Number | 1659544336
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Entity Type | Organization
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Legal Business Name | GLEN RAY BAKER JR P S C
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1007 CUMBERLAND FALLS HWY
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City | CORBIN
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State | KY
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Zip | 40701-2714
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Country | US
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Telephone | 606-523-1553
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 RAVENWOOD DR
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City | CORBIN
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State | KY
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Zip | 40701-2172
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Country | US
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Telephone | 606-523-1553
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Fax | 606-523-1593
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLEN RAY BAKER JR.
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Credential | M.D.
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Telephone | 606-523-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 15090
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License Number State | KY
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