Healthcare Provider Details

I. General information

NPI: 1508863218
Provider Name (Legal Business Name): ELIZABETH A BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9695 S YOSEMITE ST STE 324
LONE TREE CO
80124-2890
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-706-9054
  • Fax: 303-302-9799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0039720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: