MEDICARE: ALEX WADE 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	225100000X	Physical Therapist	1635	AR
2	363A00000X	Physician Assistant	PA9110930	FL
3	363A00000X	Physician Assistant	PA-536	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467876615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX WADE BAKER PA-C

Provider Business Mailing Address
First Line	:	710 MARION ST
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4832
Country	:	US
Telephone Number	:	501-278-2800
Fax Number	:	501-203-0592

Provider Business Practice Location Address
First Line	:	710 MARION ST
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4832
Country	:	US
Telephone Number	:	501-278-2800
Fax Number	:	501-203-0592

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

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	09/16/2022

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Directions to “ ALEX WADE BAKER PA-C” Practice Location

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