Provider Demographics
NPI:1235304171
Name:BAKER, EDMOND LOWE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:LOWE
Last Name:BAKER
Suffix:JR
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 1:3306 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3404
Mailing Address - Country:US
Mailing Address - Phone:602-889-9401
Mailing Address - Fax:602-889-9404
Practice Address - Street 1:3306 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3404
Practice Address - Country:US
Practice Address - Phone:602-889-9401
Practice Address - Fax:602-889-9404
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37240207QA0401X, 207V00000X
AZ81650207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA238838OtherMASSACHUSETTS LICENSE
AZ37240OtherARIZONA LICENSE
AZ467843Medicaid