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General NPI Number Information
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NPI Number | 1235304171
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Entity Type | Individual
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Provider Name | EDMOND LOWE BAKER JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 3306 W ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85009-3404
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Country | US
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Telephone | 602-889-9401
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Fax | 602-889-9404
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Provider Business Mailing Address
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Address Line | 3306 W ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85009-3404
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Country | US
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Telephone | 602-889-9401
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Fax | 602-889-9404
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 37240
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 81650
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 37240
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License Number State | AZ
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