Provider Demographics
NPI:1528487808
Name:BAKER, JEFFREY TRAVIS JR (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TRAVIS
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18473 SW 89TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7162
Mailing Address - Country:US
Mailing Address - Phone:786-490-3004
Mailing Address - Fax:954-634-4292
Practice Address - Street 1:959 WEST AVE STE 17
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5214
Practice Address - Country:US
Practice Address - Phone:786-490-6200
Practice Address - Fax:954-634-4293
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS12833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS12833Medicare PIN