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Individual

CLINTON W BAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1210 NW 16TH ST, FRUITLAND, ID 83619-2202
(208) 452-8600
(208) 452-8601
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-454
ID

Other

Enumeration date
11/02/2005
Last updated
07/29/2019
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