MEDICARE: MR. STEPHEN RANDALL BAKER N.C. LIC #788

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	237700000X	Hearing Instrument Specialist	788	NC
2	237700000X	Hearing Instrument Specialist	698	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	698	OTHER	SC	DHEC STATE LICENSE
2	778	OTHER	NC	STATE LICENSE

General Provider Information

NPI Number	:	1568734515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN RANDALL BAKER N.C. LIC #788

Provider Business Mailing Address
First Line	:	13313 OCEAN HWY UNIT 2
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-8544
Country	:	US
Telephone Number	:	843-235-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	13313 OCEAN HWY UNIT 2
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-8544
Country	:	US
Telephone Number	:	843-235-8098
Fax Number	:

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

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	08/10/2021

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Directions to “ MR. STEPHEN RANDALL BAKER N.C. LIC #788” Practice Location

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