MEDICARE: DR. BRIAN JEFFREY BAKER 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	207P00000X	Emergency Medicine Physician	A123029	CA

General Provider Information

NPI Number	:	1366609802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JEFFREY BAKER MD

Provider Business Mailing Address
First Line	:	2615 S GRAND AVE
Second Line	:	ROOM 507
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 S GRAND AVE
Second Line	:	ROOM 507
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:	213-745-3954
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	12/26/2012

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