Provider Demographics
NPI:1124892542
Name:BAKER, JUSTIN GENE (CG61503996)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GENE
Last Name:BAKER
Suffix:
Gender:M
Credentials:CG61503996
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 E D ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-2137
Mailing Address - Country:US
Mailing Address - Phone:253-324-3535
Mailing Address - Fax:
Practice Address - Street 1:3302 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1805
Practice Address - Country:US
Practice Address - Phone:253-528-4267
Practice Address - Fax:253-999-5740
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist