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General NPI Number Information
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NPI Number | 1932113735
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Entity Type | Individual
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Provider Name | BAKER A MITCHELL III MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 100 N RICHARD JACKSON BLVD STE 120
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407
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Country | US
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Telephone | 850-226-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 345 FLATWOODS FOREST LOOP
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-8843
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Country | US
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Telephone | 210-884-3779
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 254963
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | P1108
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | P1108
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME134995
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License Number State | FL
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