Healthcare Provider Details

I. General information

NPI: 1275635278
Provider Name (Legal Business Name): GARY HUNGERFORD BAKER M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RENNER DR
FORTUNA CA
95540-3120
US

IV. Provider business mailing address

PO BOX 6640
EUREKA CA
95502-6640
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-3361
  • Fax:
Mailing address:
  • Phone: 707-445-5431
  • Fax: 707-445-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA22964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: