Provider Demographics
NPI:1164043303
Name:BAKER, BRYAN ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ALEXANDER
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 SOUTH 31ST STREET
Mailing Address - Street 2:MS-09-C513C
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508
Mailing Address - Country:US
Mailing Address - Phone:937-570-5509
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST # 9C513C
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0569
Practice Address - Country:US
Practice Address - Phone:254-724-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10071290207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine