Provider Demographics
NPI:1518943141
Name:BAKER, JOEL LEN (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:LEN
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:P.O. BOX 365
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-0365
Mailing Address - Country:US
Mailing Address - Phone:641-932-7172
Mailing Address - Fax:641-932-7174
Practice Address - Street 1:417 S. EAST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02857207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2116517Medicaid
F86044Medicare UPIN
IAF86044Medicare UPIN