Provider Demographics
NPI:1275603193
Name:BAKER, JEFFREY B (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:B
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 1:187 E. 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-497-0500
Mailing Address - Fax:208-497-0505
Practice Address - Street 1:187 E. 13TH ST.
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-497-0500
Practice Address - Fax:208-497-0198
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0035860000Medicaid
ID0035860000Medicaid
ID1124716Medicare PIN