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General NPI Number Information
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NPI Number | 1164650974
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Entity Type | Individual
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Provider Name | RYAN L BAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2299 9TH AVE N STE 1A
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City | ST PETERSBURG
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State | FL
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Zip | 33713-6851
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Country | US
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Telephone | 727-655-9854
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Fax | 727-592-2194
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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Fax | 855-876-6218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME113210
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License Number State | FL
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