Provider Demographics
NPI:1558533273
Name:BAKER, ADAM PARKS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PARKS
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 1:10000 SE MAIN ST STE 224
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2469
Mailing Address - Country:US
Mailing Address - Phone:503-261-6961
Mailing Address - Fax:503-261-6959
Practice Address - Street 1:10000 SE MAIN ST STE 224
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2469
Practice Address - Country:US
Practice Address - Phone:503-261-6961
Practice Address - Fax:503-261-6959
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154995207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500654149Medicaid
OR500654149Medicaid