Healthcare Provider Details

I. General information

NPI: 1760043822
Provider Name (Legal Business Name): DR. RUSSELL BARRE BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 11TH ST
CARROLLTON KY
41008-1435
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-3280
  • Fax: 502-575-6234
Mailing address:
  • Phone: 502-588-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number247793
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number247793
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: