Provider Demographics
NPI:1154436327
Name:BAKER, JOSEPH D II (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:BAKER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 LOCH MEADE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9368
Mailing Address - Country:US
Mailing Address - Phone:216-410-1860
Mailing Address - Fax:
Practice Address - Street 1:1500 W POPLAR AVE STE 202
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0601
Practice Address - Country:US
Practice Address - Phone:901-861-9090
Practice Address - Fax:901-961-9099
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004158207RG0300X
MS30819207RG0300X
TN5026207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0662797Medicaid
OHBA7327841Medicare ID - Type Unspecified
OH0662797Medicaid