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General NPI Number Information
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NPI Number | 1922003235
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Entity Type | Individual
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Provider Name | BEN FOWLER BAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3400 E FRANK PHILLIPS BLVD STE 202
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2407
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Country | US
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Telephone | 918-335-1515
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Fax | 918-331-2519
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Provider Business Mailing Address
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Address Line | 3400 E FRANK PHILLIPS BLVD STE 202
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City | BARTLESVILLE
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State | OK
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Zip | 74006-2407
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Country | US
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Telephone | 918-335-1515
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Fax | 918-331-2519
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 12625
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License Number State | OK
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