| NPI | 1083696967 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2005-11-16 |
| Last Updated | 2010-07-19 |
| Mailing Address | 1880 John Adams Pkwy Idaho Falls, ID 83401-4315 United States Phone: (208) 524-6633 | Fax: (208) 524-9952 📍 View Map |
| Primary Practice Address | 1880 John Adams Pkwy Idaho Falls, ID 83401-4315 United States Phone: (208) 524-6633 | Fax: (208) 524-9952 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| Other (non-Medicare) | ID | 000010001770 | Blue Shield provider numb |
| Other (non-Medicare) | ID | 000010027582 | Blue Shield Group |
| MEDICAID | ID | 002796800 | - |
| Other (non-Medicare) | ID | 080097138 | RR Medicare |
| Other (non-Medicare) | ID | 1134140148 | baker family GROUP NPI |
| Other (non-Medicare) | ID | 266877 | DMBA |
| Other (non-Medicare) | ID | 72132 | Idaho Blue Cross Provider |
| MEDICAID | ID | 807937700 | - |
| Other (non-Medicare) | ID | 8K123 | Blue Cross Group |
| Other (non-Medicare) | ID | DE1614 | RR MEDICARE GRP |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 207Q00000X – Family Medicine | ID | M2619 |
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About NPI 1083696967
Wallace C Baker M.D. is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1083696967. The primary specialty listed is Family Medicine. The provider is located in Idaho Falls, ID. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2005-11-16. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1083696967?
NPI 1083696967 belongs to Wallace C Baker M.D., a Family Medicine in Idaho Falls, ID. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1083696967 active?
The current status of NPI 1083696967 in the NPPES registry is Active. The record was last updated on 2010-07-19.
What specialty is NPI 1083696967?
NPI 1083696967 is classified under the taxonomy Family Medicine. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1083696967?
You can verify NPI 1083696967 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1083696967?
The primary practice address on file for NPI 1083696967 is 1880 John Adams Pkwy, Idaho Falls, ID 83401-4315. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1083696967 issued?
NPI 1083696967 was first issued (enumerated) on 2005-11-16. The NPPES record was last updated on 2010-07-19.
Practice Location Map
Wallace C Baker is located at 1880 John Adams Pkwy, Idaho Falls, ID. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Wallace C Baker. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1083696967. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Family Medicine | M2619 | ID |