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Individual

DR. JAY P BAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Mailing address
108 S HICKORY ST, MOUNT VERNON, MO 65712-1407
(417) 466-4110
(417) 466-4255

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
36747
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
36747
MO
208D00000X
General Practice Physician
Primary
36747
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
243677937
MO
01
P00189701
RR MEDICARE
Enumeration date
06/23/2005
Last updated
01/26/2024
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