Provider Demographics
NPI:1407962558
Name:BAKER, TAMMY EWAYNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:EWAYNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:BAKER
Other - Last Name:BASIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2013 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916
Mailing Address - Country:US
Mailing Address - Phone:865-522-3440
Mailing Address - Fax:865-637-7195
Practice Address - Street 1:2013 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916
Practice Address - Country:US
Practice Address - Phone:865-522-3440
Practice Address - Fax:865-637-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN024034207VG0400X
TN24034207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN024034OtherLICENSE
TN3076178Medicare PIN
TN024034OtherLICENSE