Provider Demographics
NPI:1891797080
Name:BAKER, KEITH ANDREW (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ANDREW
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:110 W. ENT AVE.
Mailing Address - Street 2:21 MDOS/SGOF -FAMILY PRACTICE
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-2273
Mailing Address - Fax:719-566-1226
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:21 MDOS/SGOF -FAM HLTH
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-2273
Practice Address - Fax:719-556-1226
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO26315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263151Medicaid
CO01263151Medicaid