Individual
DR. JONATHAN GLENN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
984 WEST BROADWAY, SUITE 4, JACKSON, WY 83001-0000
(307) 734-1800
(307) 734-5012
Mailing address
PO BOX 14510, JACKSON, WY 83002-4510
(307) 734-1800
(307) 734-5012
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
8097A
WY
207N00000X
Dermatology Physician
A55560
CA
Other
Enumeration date
11/22/2005
Last updated
08/04/2014
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