Wallace Bakers Mid-Level Group
NPI #1639370810 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1639370810
- Entity Type
- Organization
- Organization Name
- Wallace Bakers Mid-Level Group
- Primary Specialty
- Physician Assistant - Medical
- Enumeration Date
- May 29, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 1880 JOHN ADAMS PKWY
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83401-4315
- Phone
- (208) 524-6633
Authorized Official
- Name
- DR. WALLACE COLEMAN BAKER, MD
- Title
- CEO
- Phone
- (208) 524-6633
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant - Medical — Medical |
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