Provider Demographics
NPI:1629264254
Name:BAKER CENTER FOR PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:BAKER CENTER FOR PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-563-3318
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 3050
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-563-3318
Mailing Address - Fax:303-563-3319
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 3050
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-563-3318
Practice Address - Fax:303-563-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43027208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83381872Medicaid
CO83381872Medicaid
COI07607Medicare UPIN