Individual
DR. JOHNATHAN C BAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 255-3690
(318) 251-6257
Mailing address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 255-3690
(318) 251-6257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.203777
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP10028371
BASIC PERMIT
TX
Enumeration date
09/20/2007
Last updated
06/03/2010
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