Provider Demographics
NPI:1578576955
Name:BAKER, DOUGLAS VANCE (DPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:VANCE
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-6409
Mailing Address - Country:US
Mailing Address - Phone:918-225-5711
Mailing Address - Fax:
Practice Address - Street 1:1022 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4102
Practice Address - Country:US
Practice Address - Phone:918-225-2200
Practice Address - Fax:918-225-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist