MEDICARE: MR. HORACE LANNIS BAKER LPTA

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	171000000X	Military Health Care Provider	1227	SC

General Provider Information

NPI Number	:	1427261965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HORACE LANNIS BAKER LPTA

Provider Business Mailing Address
First Line	:	5731 WELLS FARGO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5219
Country	:	US
Telephone Number	:	719-526-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 WELLS FARGO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5219
Country	:	US
Telephone Number	:	719-532-0289
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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