Provider Demographics
NPI:1386663268
Name:BAKER, DAVID P JR (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184547103Medicaid
TX8Y0323OtherBLUE CROSS BLUE SHIELD
TXP01030484OtherRR MEDICARE
TX184547102Medicaid
TXP01333574OtherRR MEDICARE
TX184547104Medicaid
TX184547101Medicaid
TX8Y0323OtherBLUE CROSS BLUE SHIELD
TXP01030484OtherRR MEDICARE
TX184547103Medicaid
TX8G9489Medicare PIN