MEDICARE: DR. EDMOND LOWE BAKER JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	37240	AZ
2	207V00000X	Obstetrics & Gynecology Physician	81650	AZ
3	207V00000X	Obstetrics & Gynecology Physician	37240	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	238838	OTHER	MA	MASSACHUSETTS LICENSE
2	37240	OTHER	AZ	ARIZONA LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235304171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMOND LOWE BAKER JR. MD

Provider Business Mailing Address
First Line	:	3306 W ROOSEVELT ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-3404
Country	:	US
Telephone Number	:	602-889-9401
Fax Number	:	602-889-9404

Provider Business Practice Location Address
First Line	:	3306 W ROOSEVELT ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-3404
Country	:	US
Telephone Number	:	602-889-9401
Fax Number	:	602-889-9404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	03/23/2022

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Directions to “ DR. EDMOND LOWE BAKER JR. MD” Practice Location

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