Provider Demographics
NPI:1275517070
Name:BAKER, SAMUEL SUMPTER
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:SUMPTER
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS COURT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7813
Mailing Address - Country:US
Mailing Address - Phone:209-521-9661
Mailing Address - Fax:209-521-9307
Practice Address - Street 1:1401 SPANOS COURT
Practice Address - Street 2:SUITE 230
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2816
Practice Address - Country:US
Practice Address - Phone:209-521-9661
Practice Address - Fax:209-521-9307
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36900207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902828841Medicaid
CA1902828841Medicaid