Provider Demographics
NPI:1083654206
Name:BAKER, GREGORY E (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3494
Mailing Address - Country:US
Mailing Address - Phone:727-953-9041
Mailing Address - Fax:727-953-9043
Practice Address - Street 1:4140 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3494
Practice Address - Country:US
Practice Address - Phone:727-953-9041
Practice Address - Fax:727-953-9043
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO119352207Q00000X
FLME131352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH01307Medicare UPIN