Provider Demographics
NPI:1912922964
Name:BAKER, STEPHEN WESLEY (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FAWCETT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1900
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:
Practice Address - Street 1:2502 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1328
Practice Address - Country:US
Practice Address - Phone:253-841-4653
Practice Address - Fax:253-446-3973
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004489363A00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093156Medicaid
WA0395156OtherL&I-DIAGNOSTIC IMAGING NW
WA0226688OtherL&I-TRA REST OF WA
WA0375582OtherL&I-UNION AVE OPEN MRI
WA8951841OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST