Provider Demographics
NPI:1336143957
Name:BAKER, SCOTT B (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3550 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4225
Mailing Address - Country:US
Mailing Address - Phone:904-733-4444
Mailing Address - Fax:904-733-5377
Practice Address - Street 1:3550 UNIVERSITY BLVD S
Practice Address - Street 2:STE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4225
Practice Address - Country:US
Practice Address - Phone:904-733-4444
Practice Address - Fax:904-733-5377
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 35731207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00576881AMedicaid
FL4047704OtherAETNA
FL068336100Medicaid
FL060013145OtherRAILROAD MEDICARE
FL102435OtherAVMED
FL79805OtherBCBS
GA00576881AMedicaid
FL79805OtherBCBS
FL102435OtherAVMED
FL79805UMedicare UPIN