MEDICARE: PAUL BAKER MD PC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1548668429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL BAKER MD PC

Provider Business Mailing Address
First Line	:	9703 PINEDALE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2443
Country	:	US
Telephone Number	:	719-332-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	9703 PINEDALE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2443
Country	:	US
Telephone Number	:	719-332-5636
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL L BAKER
Credential	:	MD
Telephone Number	:	719-332-5636

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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