Provider Demographics
NPI:1699581561
Name:BAKER, THOMAS LANE
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LANE
Last Name:BAKER
Suffix:
Gender:X
Credentials:
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TOM BAKER
Mailing Address - Street 1:5338 RAPIDO RD
Mailing Address - Street 2:A-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033
Mailing Address - Country:US
Mailing Address - Phone:424-272-5512
Mailing Address - Fax:
Practice Address - Street 1:5338 RAPIDO RD
Practice Address - Street 2:A-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033
Practice Address - Country:US
Practice Address - Phone:424-272-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOGC069171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty