MEDICARE: JAIME BAKER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	52262001206	UT

General Provider Information

NPI Number	:	1316957863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME BAKER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-501-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 E 11400 S
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-6946
Country	:	US
Telephone Number	:	801-571-0030
Fax Number	:	801-553-3196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	06/07/2016

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Directions to “ JAIME BAKER PA-C” Practice Location

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