Provider Demographics
NPI:1154360436
Name:BAKER, DUSTIN R (MD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:R
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 1:7530 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4921
Mailing Address - Country:US
Mailing Address - Phone:405-470-6510
Mailing Address - Fax:405-470-6520
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4921
Practice Address - Country:US
Practice Address - Phone:405-470-6510
Practice Address - Fax:405-470-6520
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI48691Medicare UPIN
OK200078380AMedicaid