Organization
ST JOHNS CARDIOVASCULAR PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD A BAKER MD (PRESIDENT)
(904) 810-1045
Entity
Organization
Contact information
Practice address
300 HEALTH PARK BLVD, STE 1000, ST AUGUSTINE, FL 32086-3707
(904) 810-1045
(904) 810-1046
Mailing address
PO BOX 348, ST AUGUSTINE, FL 32085-0348
(904) 810-1045
(904) 810-1046
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME45744
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0636515100
—
FL
01
—
DG3336
RR MEDICARE
FL
Enumeration date
05/31/2007
Last updated
01/11/2011
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