Provider Demographics
NPI:1063464279
Name:BAKER, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
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 4540
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702
Mailing Address - Country:US
Mailing Address - Phone:866-964-3795
Mailing Address - Fax:
Practice Address - Street 1:1470 MEDICAL PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4648
Practice Address - Country:US
Practice Address - Phone:775-445-7650
Practice Address - Fax:775-687-8457
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11681207RC0000X
CAA94733207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508136Medicaid
NVEN478ZOtherMEDICARE PTAN FOR CTPC
NVEN478ZOtherMEDICARE PTAN FOR CTPC