Provider Demographics
NPI:1194892869
Name:SOLON BAKER, LAURA JUNE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JUNE
Last Name:SOLON BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 BOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5907
Mailing Address - Country:US
Mailing Address - Phone:813-362-1171
Mailing Address - Fax:813-221-4039
Practice Address - Street 1:5105 BOWDEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5907
Practice Address - Country:US
Practice Address - Phone:904-374-0260
Practice Address - Fax:904-619-5463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026136207L00000X
NY152815207L00000X
FLME79370207LP2900X, 207Q00000X, 261QP2300X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258429800Medicaid
FL49789CMedicare ID - Type Unspecified