Provider Demographics
NPI:1518079722
Name:BAKER, BRUCE K (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:K
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 3RD ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3702
Mailing Address - Country:US
Mailing Address - Phone:253-268-3345
Mailing Address - Fax:253-881-1490
Practice Address - Street 1:1408 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-268-3345
Practice Address - Fax:253-881-1490
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001533207Q00000X
WA89983087207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0391445OtherDEPARTMENT OF LABOR INDUSTRIES
080182015OtherRAILROAD MEDICARE
WA1115179Medicaid
G70317Medicare UPIN
WA1115179Medicaid