Provider Demographics
NPI:1073613212
Name:BAKER, DANA RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:RAY
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:R
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:402 W PALM VALLEY BLVD STE A123
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4200
Mailing Address - Country:US
Mailing Address - Phone:512-496-0394
Mailing Address - Fax:512-249-1719
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5094
Practice Address - Country:US
Practice Address - Phone:512-496-0394
Practice Address - Fax:512-249-1719
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3729207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3450OtherBLUE CROSS BLUE SHIELD
TX039016301Medicaid
TX8166MOMedicare PIN
TX039016301Medicaid