Basic Information
| Provider Information | |||||||||
| NPI: | 1083228704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 CABELAS DR APT 822 | ||||||||
| Address2: | |||||||||
| City: | BUDA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786106216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134191297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3403B GARDEN VILLA LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2020 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | RBT-20-127332 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.