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General NPI Number Information
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NPI Number | 1750444972
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Entity Type | Organization
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Legal Business Name | ROLA P BAKER MD PC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 2282 NW TROOST ST SUITE 102
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City | ROSEBURG
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State | OR
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Zip | 97470-6071
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Country | US
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Telephone | 541-440-9128
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Fax | 541-440-9130
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Provider Business Mailing Address
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Address Line | 2282 NW TROOST ST SUITE 102
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City | ROSEBURG
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State | OR
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Zip | 97470-6071
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Country | US
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Telephone | 541-440-9128
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Fax | 541-440-9130
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROLA P. BAKER
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Credential | MD
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Telephone | 541-440-9128
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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 | MD16652
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License Number State | OR
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