Individual
JOHN A BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 302, TWIN FALLS, ID 83301-5814
(208) 814-8600
(208) 814-8942
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M8866
ID
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
M8866
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806703100
—
ID
01
—
P00095566
RR MEDICARE
ID
Enumeration date
06/14/2006
Last updated
12/04/2014
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