Provider Demographics
NPI:1497775522
Name:BAKER, GREGORY J (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-356-4067
Mailing Address - Fax:702-333-8466
Practice Address - Street 1:5400 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1859
Practice Address - Country:US
Practice Address - Phone:702-853-3000
Practice Address - Fax:702-333-8466
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTPOS6072084N0400X
NVDO14732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497775522Medicaid
NVBV280ZMedicare PIN