Provider Demographics
NPI:1871202424
Name:BAKER, MYRON ORLANDO
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:ORLANDO
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7477 COMMONS BLVD APT 625
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2353
Mailing Address - Country:US
Mailing Address - Phone:423-424-8647
Mailing Address - Fax:
Practice Address - Street 1:7477 COMMONS BLVD APT 625
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2353
Practice Address - Country:US
Practice Address - Phone:423-424-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)