Provider Demographics
NPI:1447384045
Name:GARY L BAKER, MD., PA
Entity Type:Organization
Organization Name:GARY L BAKER, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-599-5009
Mailing Address - Street 1:8787 BALLENTINE STREET
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1987
Mailing Address - Country:US
Mailing Address - Phone:913-599-5009
Mailing Address - Fax:913-599-5212
Practice Address - Street 1:8787 BALLENTINE STREET
Practice Address - Street 2:SUITE 2800
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1987
Practice Address - Country:US
Practice Address - Phone:913-599-5009
Practice Address - Fax:913-599-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A02072Medicare UPIN
KS0000965AMedicare ID - Type Unspecified