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NPI Code Detail

MEDICARE: BENJAMIN JAMES BAIRD P.A.-C.

MEDICARE: BENJAMIN JAMES BAIRD P.A.-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
1363AS0400XSurgical Physician AssistantPA172681OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA172681OTHERORLICENSE

General Provider Information

NPI Number : 1417252990
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN JAMES BAIRD P.A.-C.
Provider Business Mailing Address
First Line : 1813 W HARVARD AVE STE 110
Second Line :
City : ROSEBURG
State : OR
Zip : 97471-2753
Country : US
Telephone Number : 541-391-8155
Fax Number : 541-391-8154
Provider Business Practice Location Address
First Line : 1813 W HARVARD AVE STE 110
Second Line :
City : ROSEBURG
State : OR
Zip : 97471-2753
Country : US
Telephone Number : 541-391-8155
Fax Number : 541-391-8154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2011
Last Update Date : 02/10/2026

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