Healthcare Provider Details

I. General information

NPI: 1316151590
Provider Name (Legal Business Name): GERALD G BAKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST SUITE 1014
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

1260 15TH ST SUITE 1014
SANTA MONICA CA
90404-1135
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-1618
  • Fax: 310-395-6747
Mailing address:
  • Phone: 310-451-1618
  • Fax: 310-395-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE1735
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberE1735
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: