Individual
MR. NATHAN T BAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2605 E CREEKS EDGE DR, BLOOMINGTON, IN 47401-8368
(812) 355-2300
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000593A
IN
363A00000X
Physician Assistant
1000593A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300009627
—
IN
Enumeration date
06/21/2006
Last updated
09/02/2022
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