Provider Demographics
NPI:1306397849
Name:BAKER, BROCK (MD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 800022 SUITE 303 (BUILDING 2)
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:1 MERCADO ST STE 100CC
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-385-4746
Practice Address - Fax:970-259-5787
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2024-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.00654552085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology