Provider Demographics
NPI:1386660298
Name:BAKER, DENISE L (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3651 CORTEZ RD W SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3467
Mailing Address - Country:US
Mailing Address - Phone:941-748-6161
Mailing Address - Fax:941-761-4478
Practice Address - Street 1:3651 CORTEZ RD W STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3167
Practice Address - Country:US
Practice Address - Phone:941-748-6161
Practice Address - Fax:941-761-4478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60728207VG0400X
FLME0060728208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12891OtherBCBS
FL160015194OtherRAILROADL MEDICARE
E39249Medicare UPIN
FL12891ZMedicare ID - Type Unspecified