MEDICARE: BRIAN BAKER PHD

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	174400000X	Specialist

General Provider Information

NPI Number	:	1962045237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BAKER PHD

Provider Business Mailing Address
First Line	:	7076 S CHERRY LEAF DR APT 106
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84084-5778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8796 S 4770 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-4930
Country	:	US
Telephone Number	:	714-876-4111
Fax Number	:

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

Provider Enumeration Date	:	10/19/2019
Last Update Date	:	10/19/2019

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Directions to “ BRIAN BAKER PHD” Practice Location

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