Provider Demographics
NPI:1992793293
Name:BAKER, ROBERT R (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17000
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-7000
Mailing Address - Country:US
Mailing Address - Phone:479-314-4000
Mailing Address - Fax:479-314-4050
Practice Address - Street 1:2800 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6523
Practice Address - Country:US
Practice Address - Phone:479-314-4000
Practice Address - Fax:479-314-4050
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122045003Medicaid
OK100200680DMedicaid
AR55864Medicare ID - Type Unspecified
ARC60007Medicare UPIN