Provider Demographics
NPI:1578547238
Name:BAKER, RICHARD LEE (DPM)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:760 MOUNT ZION RD NW
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-4547
Mailing Address - Country:US
Mailing Address - Phone:423-473-9180
Mailing Address - Fax:
Practice Address - Street 1:2850 OCOEE ST N
Practice Address - Street 2:BRADLEY FAMILY FOOT CARE STE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5385
Practice Address - Country:US
Practice Address - Phone:423-559-1555
Practice Address - Fax:423-559-2455
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDPM543213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU75121Medicare UPIN
TN3353003Medicare ID - Type UnspecifiedMEDICARE