Healthcare Provider Details

I. General information

NPI: 1881898120
Provider Name (Legal Business Name): CARLTON ANDREW BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17450 S LA CANADA DR
SAHUARTIA AZ
85629-9718
US

IV. Provider business mailing address

17450 S LA CANADA DR
SAHUARTIA AZ
85629-9718
US

V. Phone/Fax

Practice location:
  • Phone: 520-393-0898
  • Fax:
Mailing address:
  • Phone: 520-393-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number17562
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: