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General NPI Number Information
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NPI Number | 1831191899
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Entity Type | Individual
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Provider Name | BRUCE C BAKER PA
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Gender | Male
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 JEFFERSON ST
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City | WEST UNION
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State | IA
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Zip | 52175-1022
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Country | US
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Telephone | 563-422-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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Fax | 608-775-4467
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 823
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License Number State | IA
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