Provider Demographics
NPI:1316151590
Name:BAKER, GERALD G (DPM)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:G
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 1014
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-451-1618
Mailing Address - Fax:310-395-6747
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 1014
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-451-1618
Practice Address - Fax:310-395-6747
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1735213E00000X, 213EP1101X, 213ER0200X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0207250001OtherMEDICARE DME
CAWE6504OtherMEDICARE GROUP NUMBER
CAE1735OtherSTATE LICENSE NUMBER
CA1043245525OtherGROUP NPI
CAWE1735BMedicare ID - Type UnspecifiedINDIVITUAL RENDERING PIN
CA0207250001OtherMEDICARE DME