Provider Demographics
NPI:1427052042
Name:BAKER, RONALD FREDRICK (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:FREDRICK
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 B GEROGE DIETER
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7601
Mailing Address - Country:US
Mailing Address - Phone:915-855-7900
Mailing Address - Fax:915-855-7755
Practice Address - Street 1:1418 B GEORGE DIETER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-855-7900
Practice Address - Fax:915-855-7755
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165304005Medicaid
TX165304005Medicaid
TX8G3421Medicare PIN