Provider Demographics
NPI:1154372167
Name:BAKER, MATTHEW JAMES (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
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 1:3200 BAILEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8523
Mailing Address - Country:US
Mailing Address - Phone:239-262-8971
Mailing Address - Fax:239-262-5903
Practice Address - Street 1:3200 BAILEY LN STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8523
Practice Address - Country:US
Practice Address - Phone:239-262-8971
Practice Address - Fax:239-262-5903
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME819732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02597OtherBCBS
FL261598300Medicaid
FLBB7221269OtherDEA
FLE5255ZMedicare ID - Type Unspecified
FL261598300Medicaid