Provider Demographics
NPI:1043296098
Name:BAKER, STEPHEN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2841 DEBARR RD
Mailing Address - Street 2:BLDG A, SUITE 23
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2958
Mailing Address - Country:US
Mailing Address - Phone:907-677-1864
Mailing Address - Fax:907-868-5167
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:BLDG A, SUITE 23
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2958
Practice Address - Country:US
Practice Address - Phone:907-677-1864
Practice Address - Fax:907-868-5167
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0366Medicaid