Provider Demographics
NPI:1699894840
Name:BAKER, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:4730 COLLEGE DR
Mailing Address - Street 2:P O BOX 2231
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4009
Mailing Address - Country:US
Mailing Address - Phone:940-552-9901
Mailing Address - Fax:
Practice Address - Street 1:4730 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4009
Practice Address - Country:US
Practice Address - Phone:940-552-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1027Medicare ID - Type Unspecified
TXC13080Medicare UPIN