Provider Demographics
NPI:1629264189
Name:BAKER, ROBERT LEE (C-PED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5362
Mailing Address - Country:US
Mailing Address - Phone:620-275-4712
Mailing Address - Fax:620-260-9668
Practice Address - Street 1:211 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5362
Practice Address - Country:US
Practice Address - Phone:620-275-4712
Practice Address - Fax:620-260-9668
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6080160001Medicare NSC