Provider Demographics
NPI:1033408364
Name:BAKER, ROGER SETH (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:SETH
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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 614
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-0614
Mailing Address - Country:US
Mailing Address - Phone:903-247-2050
Mailing Address - Fax:903-934-8280
Practice Address - Street 1:2901 N. 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:903-247-2050
Practice Address - Fax:903-934-8280
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4716207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology