Healthcare Provider Details

I. General information

NPI: 1992970602
Provider Name (Legal Business Name): CLYDE GREGORY BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

IV. Provider business mailing address

DEPT 354 PO BOX 509015
SAN DIEGO CA
92150-9015
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax: 706-653-1162
Mailing address:
  • Phone: 800-406-4558
  • Fax: 706-653-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number260746
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC199874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: