Provider Demographics
NPI:1386605590
Name:BAKER, NOEL SUSAN (MD)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:SUSAN
Last Name:BAKER
Suffix:
Gender:
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST STE 330
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8368
Practice Address - Country:US
Practice Address - Phone:903-510-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK57912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977052OtherTRICARE
TX8W6743OtherBCBS
TX752616977103OtherTRICARE
TX284588501Medicaid
TX106201002Medicaid
TX752616977095OtherTRICARE
TX752616977052OtherTRICARE
TX8W6743OtherBCBS
F21425Medicare UPIN
TX284588501Medicaid