Provider Demographics
NPI:1093775595
Name:BAKER, JACOB D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:CRNA
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Other - First Name:
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Mailing Address - Street 1:5605 N. MACARTHUR BOULEVARD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:972-714-0007
Mailing Address - Fax:972-714-0009
Practice Address - Street 1:5605 N. MACARTHUR BOULEVARD
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-714-0007
Practice Address - Fax:972-714-0009
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX692551367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered