Healthcare Provider Details

I. General information

NPI: 1366609802
Provider Name (Legal Business Name): BRIAN JEFFREY BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 S GRAND AVE ROOM 507
LOS ANGELES CA
90007-2608
US

IV. Provider business mailing address

2615 S GRAND AVE ROOM 507
LOS ANGELES CA
90007-2608
US

V. Phone/Fax

Practice location:
  • Phone: 213-745-3954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA123029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: