Healthcare Provider Details

I. General information

NPI: 1275603193
Provider Name (Legal Business Name): JEFFREY B BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 E. 13TH ST.
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

187 E. 13TH ST.
IDAHO FALLS ID
83404
US

V. Phone/Fax

Practice location:
  • Phone: 208-497-0500
  • Fax: 208-497-0198
Mailing address:
  • Phone: 208-497-0500
  • Fax: 208-497-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5835
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: