Provider Demographics
NPI:1609190032
Name:BAKER, CALEB ROY (DPM)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:ROY
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 FRONTIER STREET
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:720-552-6101
Mailing Address - Fax:720-552-6102
Practice Address - Street 1:1351 FRONTIER STREET
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:720-552-6101
Practice Address - Fax:720-552-6102
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000718213ES0103X
WY140213ES0103X
PASC006177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW24915OtherMEDICARE PTAN