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General NPI Number Information
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NPI Number | 1912128307
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Entity Type | Individual
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Provider Name | BRIAN L BAKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 85 TOWER CIRCLE
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-772-3376
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Fax | 606-677-0335
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Provider Business Mailing Address
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Address Line | PO BOX 3535
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City | WEST SOMERSET
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State | KY
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Zip | 42564-3535
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Country | US
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Telephone | 606-772-3376
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Fax | 606-677-0335
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 39921
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 39921
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2007011366
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License Number State | MO
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