Provider Demographics
NPI:1124081658
Name:BAKER, BIRON D (MD)
Entity type:Individual
Prefix:MR
First Name:BIRON
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 COLEMAN ST
Mailing Address - Street 2:STE 107
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1371
Mailing Address - Country:US
Mailing Address - Phone:701-751-4340
Mailing Address - Fax:
Practice Address - Street 1:4401 COLEMAN ST
Practice Address - Street 2:STE 107
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1371
Practice Address - Country:US
Practice Address - Phone:701-751-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00015728Medicaid
ND18973Medicaid
ND18973Medicaid
NDG29866Medicare UPIN
NDN716711Medicare PIN