Provider Demographics
NPI:1154334522
Name:BAKER, JEFFREY TRAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TRAVIS
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 1:106 AYSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5034
Mailing Address - Country:US
Mailing Address - Phone:985-645-9420
Mailing Address - Fax:985-649-4063
Practice Address - Street 1:106 AYSHIRE CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5034
Practice Address - Country:US
Practice Address - Phone:985-645-9420
Practice Address - Fax:985-649-4063
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1352853Medicaid
LA50495Medicare ID - Type Unspecified
LAB62435Medicare UPIN