Provider Demographics
NPI:1366939217
Name:BAKER, VIRGIL WAYNE (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:WAYNE
Last Name:BAKER
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E. MOODY BLVD
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-7710
Mailing Address - Country:US
Mailing Address - Phone:386-263-2833
Mailing Address - Fax:386-313-5134
Practice Address - Street 1:4750 E. MOODY BLVD
Practice Address - Street 2:SUITE # 105
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7710
Practice Address - Country:US
Practice Address - Phone:386-263-2833
Practice Address - Fax:386-313-5134
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2907237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist