Provider Demographics
NPI:1962583740
Name:BAKER, DAVID NICHOLAS (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:736 E BULLARD AVE
Mailing Address - Street 2:S-101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5473
Mailing Address - Country:US
Mailing Address - Phone:559-437-9700
Mailing Address - Fax:559-437-9799
Practice Address - Street 1:736 E BULLARD AVE
Practice Address - Street 2:S-101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5473
Practice Address - Country:US
Practice Address - Phone:559-437-9700
Practice Address - Fax:559-437-9799
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22759ZMedicare ID - Type Unspecified
CA0PA128501Medicare UPIN