Healthcare Provider Details

I. General information

NPI: 1275510885
Provider Name (Legal Business Name): ROBERT K BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 SPRING CREEK RD
CHATTANOOGA TN
37412-3910
US

IV. Provider business mailing address

932 SPRING CREEK RD
CHATTANOOGA TN
37412-3910
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-1453
  • Fax: 423-899-8022
Mailing address:
  • Phone: 423-894-1453
  • Fax: 423-899-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number042-0010602
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number228400-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41220
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: