Individual
DR. MISTY DAWN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
305 N 5TH ST, LONGVIEW, TX 75601-6518
(903) 757-3338
Mailing address
305 N 5TH ST, LONGVIEW, TX 75601-6518
(903) 757-3338
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1758
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176132202
—
TX
05
—
176132203
—
TX
01
—
8BG720
BCBS PIN
TX
01
—
8EC351
BCBS PIN
TX
01
—
P00439882
MEDICARE RAILROAD
TX
Enumeration date
08/24/2005
Last updated
10/01/2014
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