Healthcare Provider Details

I. General information

NPI: 1891157343
Provider Name (Legal Business Name): ANDREW BRANTLEY BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 SE 32ND AVE STE 320
MILWAUKIE OR
97222-6596
US

IV. Provider business mailing address

10330 SE 32ND AVE STE 320
MILWAUKIE OR
97222-6596
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-8693
  • Fax:
Mailing address:
  • Phone: 503-513-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD204518
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: