Healthcare Provider Details

I. General information

NPI: 1487624664
Provider Name (Legal Business Name): TROY ROBINSON BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3943 E PONY EXPRESS PKWY
EAGLE MOUNTAIN UT
84005-5541
US

IV. Provider business mailing address

830 N 2000 W
PLEASANT GROVE UT
84062-4047
US

V. Phone/Fax

Practice location:
  • Phone: 17-895-5668
  • Fax: 801-642-2941
Mailing address:
  • Phone: 801-756-3511
  • Fax: 801-756-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number25935
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.025935
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12177649-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: