MEDICARE: JAMES W. BAKER MD

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	174400000X	Specialist	MD08914	OR
2	207K00000X	Allergy & Immunology Physician	MD08914	OR
3	207KA0200X	Allergy Physician	MD08914	OR

General Provider Information

NPI Number	:	1710982293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W. BAKER MD

Provider Business Mailing Address
First Line	:	9495 SW LOCUST ST STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-636-9011
Fax Number	:	503-636-3952

Provider Business Practice Location Address
First Line	:	9495 SW LOCUST ST STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-636-9011
Fax Number	:	503-636-3952

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/28/2015

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