Basic Information
Provider Information
NPI: 1558358564
EntityType: 2
ReplacementNPI:  
OrganizationName: TIM Y BAKER MD APMC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: PO BOX 61950
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705961950
CountryCode: US
TelephoneNumber: 3372615151
FaxNumber:  
Practice Location
Address1: 201 SAINT PATRICK ST
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705064500
CountryCode: US
TelephoneNumber: 3372615151
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2005
LastUpdateDate: 03/10/2008
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BAKER
AuthorizedOfficialFirstName: TIM
AuthorizedOfficialMiddleName: Y.
AuthorizedOfficialTitleorPosition: OWNER/MD
AuthorizedOfficialTelephone: 3372615151
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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