MEDICARE: DR. JACK ROSS BAKER DO

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	208800000X	Urology Physician	34003239B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982712899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK ROSS BAKER DO

Provider Business Mailing Address
First Line	:	4590 DRESSLER ROAD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2546
Country	:	US
Telephone Number	:	330-492-5555
Fax Number	:	330-492-7808

Provider Business Practice Location Address
First Line	:	4590 DRESSLER ROAD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2546
Country	:	US
Telephone Number	:	330-492-5555
Fax Number	:	330-492-7808

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	04/09/2010

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Directions to “ DR. JACK ROSS BAKER DO” Practice Location

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