Healthcare Provider Details

I. General information

NPI: 1073613212
Provider Name (Legal Business Name): DANA RAY BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAN R. BAKER M.D.

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHISHOLM TRAIL RD STE 450
ROUND ROCK TX
78681-5094
US

IV. Provider business mailing address

402 W PALM VALLEY BLVD STE A123
ROUND ROCK TX
78664-4200
US

V. Phone/Fax

Practice location:
  • Phone: 512-496-0394
  • Fax: 512-249-1719
Mailing address:
  • Phone: 512-496-0394
  • Fax: 512-249-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3729
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberF3729
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: