Provider Demographics
NPI:1043693104
Name:BAKER, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27TH MEDICAL GROUP/SGHC
Mailing Address - Street 2:224 W D.L. INGRAM AVE
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5103
Mailing Address - Country:US
Mailing Address - Phone:575-904-3917
Mailing Address - Fax:575-784-6028
Practice Address - Street 1:27TH MEDICAL GROUP
Practice Address - Street 2:224 W D.L. INGRAM AVE
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5103
Practice Address - Country:US
Practice Address - Phone:575-784-1103
Practice Address - Fax:575-784-0082
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR10435207Q00000X
IAMD-43832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine