Healthcare Provider Details

I. General information

NPI: 1528056785
Provider Name (Legal Business Name): STEPHEN S BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 W KALEY ST
ORLANDO FL
32806-2942
US

IV. Provider business mailing address

41 W KALEY ST
ORLANDO FL
32806-2942
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-6645
  • Fax: 407-843-4519
Mailing address:
  • Phone: 407-843-6645
  • Fax: 407-843-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME80027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: