Individual
JOE BLUNT BAKER IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12554 RIATA VISTA CIR, AUSTIN, TX 78727
(512) 795-5100
(512) 795-5122
Mailing address
817 CENTRAL AVE, WILMETTE, IL 60091-2605
(505) 715-7477
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
036.140204
IL
2085P0229X
Pediatric Radiology Physician
R1929
TX
2085R0202X
Diagnostic Radiology Physician
R1929
TX
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036.140204
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371577301
—
TX
Enumeration date
03/19/2010
Last updated
09/16/2021
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