1932364692 NPI number — BRADLEY S BAKER MD PLLC

Table of content: (NPI 1932364692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932364692 NPI number — BRADLEY S BAKER MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADLEY S BAKER MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932364692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1928 E HIGHLAND AVENUE
Provider Second Line Business Mailing Address:
F104-501
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-324-0449
Provider Business Mailing Address Fax Number:
602-266-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9327 N 3RD STREET
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-324-0449
Provider Business Practice Location Address Fax Number:
602-266-4477
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
602-324-0449

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  40754 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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