=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669619375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES D BAKER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2009
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 LINCOLN ST
-----------------------------------------------------
City | FORT MORGAN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80701-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-867-0606
-----------------------------------------------------
Fax | 970-542-3377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 LINCOLN ST
-----------------------------------------------------
City | FORT MORGAN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80701-3290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-867-0606
-----------------------------------------------------
Fax | 970-542-3377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | JAMES D BAKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 970-867-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 47063
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------