Healthcare Provider Details

I. General information

NPI: 1316161680
Provider Name (Legal Business Name): MEREDITH RAE BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 NE WYATT CT SUITE 101
BEND OR
97701-7687
US

IV. Provider business mailing address

2090 NE WYATT CT SUITE 101
BEND OR
97701-7687
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-6447
  • Fax: 541-330-7413
Mailing address:
  • Phone: 541-382-6447
  • Fax: 541-330-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD27482
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: