Healthcare Provider Details

I. General information

NPI: 1073506440
Provider Name (Legal Business Name): RICHARD D BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH MEDICAL SQUADRON UNIT 7095 BOX 185
APO AE
09824
TR

IV. Provider business mailing address

39TH MEDICAL SQUADRON UNIT 7095 BOX 185
APO AE
09824
TR

V. Phone/Fax

Practice location:
  • Phone: 011903223161677
  • Fax:
Mailing address:
  • Phone: 011903223161677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD066749L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: