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Individual
BAKER BOLES
Active
Individual
BAKER BOLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37179
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371797
—
SC
01
—
SCB0215019
MEDICARE PIN
SC
Enumeration date
06/18/2014
Last updated
12/01/2020
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