Provider Demographics
NPI:1528185501
Name:BAKER, AUDREY HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:HEATHER
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:HEAHER
Other - Last Name:ERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245074
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-6673
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-626-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45095207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology