Provider Demographics
NPI:1508861287
Name:BAKER, THEODORE D (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-838-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL227592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051522427OtherBLUE CROSS
AL009938774Medicaid
AL009938781Medicaid
AL051515362OtherBLUE CROSS
AL051522678OtherBLUE CROSS
AL051525486OtherBLUE CROSS
AL515-22683OtherBLUE CROSS
AL051522677OtherBLUE CROSS
AL051522686OtherBLUE CROSS
AL009938776Medicaid
AL051539832OtherBLUE CROSS
AL051554802Medicaid
AL7070599OtherAETNA
AL009938778Medicaid
AL051522679OtherBLUE CROSS
AL009938773Medicaid
AL009983795Medicaid
AL051522684OtherBLUE CROSS
AL009938777Medicaid
AL009938779Medicaid
AL051522681OtherBLUE CROSS
AL051522681OtherBLUE CROSS
AL051522677OtherBLUE CROSS
AL051522678OtherBLUE CROSS
AL009938773Medicaid