Provider Demographics
NPI:1629258769
Name:BAKER, RYAN SCOTT (AUD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:BAKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 NEWBERRY RD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2557
Mailing Address - Country:US
Mailing Address - Phone:352-372-9414
Mailing Address - Fax:352-271-5393
Practice Address - Street 1:4340 NEWBERRY RD.
Practice Address - Street 2:SUITE 301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2557
Practice Address - Country:US
Practice Address - Phone:352-372-9414
Practice Address - Fax:352-271-5393
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1453231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000264200Medicaid