Healthcare Provider Details

I. General information

NPI: 1114920121
Provider Name (Legal Business Name): RICHARD E BAKER JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CAMP ST STE 2
HYANNIS MA
02601-3048
US

IV. Provider business mailing address

289 PLEASANT ST STE 202
FALL RIVER MA
02721-3005
US

V. Phone/Fax

Practice location:
  • Phone: 774-470-4507
  • Fax: 774-810-7189
Mailing address:
  • Phone: 508-646-7720
  • Fax: 508-646-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberRIDPM265
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: