Organization
WALLACE C BAKER
Active
Other names
Baker Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE C. BAKER M.D. (DOCTOR)
(208) 524-6633
Entity
Organization
Contact information
Practice address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
(208) 524-9952
Mailing address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
(208) 524-9952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6919
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001770
BLUE SHILD INDIVIDUAL
ID
01
—
000010027582
BLUE SHIELD GROUP NUMBER
ID
01
—
1083696967
IND NPI NUMBER
ID
01
—
72132
BLUECROSS NUMBER
ID
05
—
807937700
—
ID
01
—
8K123
GRP BLUECROSS NO.
ID
01
—
D1614
RAILROAD MCR GROUP
ID
Enumeration date
07/22/2006
Last updated
07/19/2010
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