Individual
MR. PAUL M. BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2015 VAN ST, TUPELO, MS 38804-1043
(270) 564-0024
Mailing address
2015 VAN ST, TUPELO, MS 38804-1043
(270) 564-0024
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1565A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000361080
BCBS
—
05
—
74407354
—
KY
01
—
P00261306
RAILROAD MEDICARE
—
Enumeration date
10/02/2006
Last updated
08/26/2013
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