Baker, Wallace C
Baker, Wallace C is an sole proprietor health care provider with primary practice located at 1880 John Adams Pkwy , Idaho Falls ID 83401-4315. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Baker, Wallace C can be contacted via phone (208) 524-6633.Contact Information
Primary practice address
1880 John Adams Pkwy
Idaho Falls ID 83401-4315
Phone: (208) 524-6633
Fax: (208) 524-9952
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M2619 | Idaho |
Profile Details
| NPI number | 1083696967 |
|---|---|
| LBN Legal business name | Baker, Wallace C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 16th, 2005 |
| Last updated | Jul 19th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083696967 | NPPES |
| Idaho | Other | 000010001770 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 000010027582 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 080097138 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 8K123 | BLUE SHIELD PROVIDER NUMB |
| Idaho | MEDICAID | 002796800 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 266877 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 1134140148 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | 72132 | BLUE SHIELD PROVIDER NUMB |
| Idaho | MEDICAID | 807937700 | BLUE SHIELD PROVIDER NUMB |
| Idaho | Other | DE1614 | BLUE SHIELD PROVIDER NUMB |
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