Provider Demographics
NPI:1427261965
Name:BAKER, HORACE LANNIS (LPTA)
Entity type:Individual
Prefix:MR
First Name:HORACE
Middle Name:LANNIS
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 WELLS FARGO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5219
Mailing Address - Country:US
Mailing Address - Phone:719-526-7120
Mailing Address - Fax:
Practice Address - Street 1:5731 WELLS FARGO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5219
Practice Address - Country:US
Practice Address - Phone:719-532-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1227171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider