Healthcare Provider Details

I. General information

NPI: 1518079722
Provider Name (Legal Business Name): BRUCE K. BAKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 3RD ST SE STE 200
PUYALLUP WA
98372
US

IV. Provider business mailing address

1408 3RD ST SE STE 200
PUYALLUP WA
98372-3702
US

V. Phone/Fax

Practice location:
  • Phone: 253-268-3345
  • Fax: 253-881-1490
Mailing address:
  • Phone: 253-268-3345
  • Fax: 253-881-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001533
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number89983087
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: