Healthcare Provider Details

I. General information

NPI: 1932364692
Provider Name (Legal Business Name): BRADLEY S BAKER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 N 3RD STREET STE. 200
PHOENIX AZ
85020-2473
US

IV. Provider business mailing address

1928 E HIGHLAND AVENUE F104-501
PHOENIX AZ
85016-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-324-0449
  • Fax: 602-266-4477
Mailing address:
  • Phone: 602-324-0449
  • Fax: 602-266-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number40754
License Number StateAZ

VIII. Authorized Official

Name: DR. BRADLEY S. BAKER
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 602-324-0449