Provider Demographics
NPI:1972509974
Name:BAKER, JAY P (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1407
Mailing Address - Country:US
Mailing Address - Phone:417-466-4110
Mailing Address - Fax:417-466-4255
Practice Address - Street 1:1540 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4300
Practice Address - Country:US
Practice Address - Phone:417-823-2900
Practice Address - Fax:417-886-2774
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36747207L00000X, 207LP2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243677937Medicaid
P00189701OtherRR MEDICARE
P00189701OtherRR MEDICARE
MO243677937Medicaid
F37121Medicare UPIN