Provider Demographics
NPI:1568533792
Name:BAKER, LARRY J (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LAURENCE
Other - Middle Name:JAMES
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:13909 OAK BROOK DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2134
Mailing Address - Country:US
Mailing Address - Phone:515-987-2574
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:S-128
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-241-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1721207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154781Medicaid
IA930039470OtherRAILROAD MEDICARE
IA2154781Medicaid
IA1154781Medicaid
IA2154781Medicaid
IA54688Medicare PIN