Provider Demographics
NPI:1184838005
Name:BAKER, BRANDON ALAN (IDC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ALAN
Last Name:BAKER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:879 CASSIDY LN
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-5215
Mailing Address - Country:US
Mailing Address - Phone:812-854-4314
Mailing Address - Fax:812-854-1339
Practice Address - Street 1:NSA CRANE MEDICAL DEPARTMENT BLDG 2516
Practice Address - Street 2:300 HWY 361
Practice Address - City:CRANE
Practice Address - State:IN
Practice Address - Zip Code:47446
Practice Address - Country:US
Practice Address - Phone:812-854-4314
Practice Address - Fax:812-854-1339
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman