Provider Demographics
NPI:1154547073
Name:BAKER, JOSHUA PAUL (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:BAKER
Suffix:
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 1:705 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50469-1035
Mailing Address - Country:US
Mailing Address - Phone:641-372-0315
Mailing Address - Fax:641-372-0304
Practice Address - Street 1:705 ELM ST E
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:IA
Practice Address - Zip Code:50469-1035
Practice Address - Country:US
Practice Address - Phone:641-372-0315
Practice Address - Fax:641-372-0304
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3995204D00000X, 207Q00000X
IN02003106A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11012682AOtherRESIDENCY PERMIT
INPENDINGMedicaid
INPENDINGMedicare ID - Type UnspecifiedRENDERING PHYSICIAN
IN11012682AOtherRESIDENCY PERMIT
INPENDINGMedicare UPIN