Provider Demographics
NPI:1508863218
Name:BAKER, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:303-719-2990
Practice Address - Street 1:9695 S YOSEMITE ST STE 324
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2890
Practice Address - Country:US
Practice Address - Phone:303-706-9054
Practice Address - Fax:303-302-9799
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94678847Medicaid
CO521748Medicare ID - Type Unspecified
CO94678847Medicaid