Provider Demographics
NPI:1073807418
Name:BAKER, SALLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:A
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 1:10120 S EASTERN AVE #130
Mailing Address - Street 2:
Mailing Address - City:HENNERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-487-6880
Mailing Address - Fax:702-473-5455
Practice Address - Street 1:10120 S EASTERN AVE #130
Practice Address - Street 2:
Practice Address - City:HENNERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-487-6880
Practice Address - Fax:702-473-5455
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451187207L00000X
PAMT199586207L00000X
NV16404207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology