Healthcare Provider Details

I. General information

NPI: 1649440603
Provider Name (Legal Business Name): SETH H. BAKER, DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 37TH ST E-140
VERO BEACH FL
32960-7305
US

IV. Provider business mailing address

787 37TH ST E-140
VERO BEACH FL
32960-7305
US

V. Phone/Fax

Practice location:
  • Phone: 772-299-0097
  • Fax:
Mailing address:
  • Phone: 772-299-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS-0007156
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS-0007156
License Number StateFL

VIII. Authorized Official

Name: SETH H BAKER
Title or Position: PRESIDENT
Credential: DO PA
Phone: 772-299-0097