Provider Demographics
NPI:1710090857
Name:BAKER, KELTY RUTH (MD)
Entity Type:Individual
Prefix:
First Name:KELTY
Middle Name:RUTH
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6560 FANNIN STREET
Mailing Address - Street 2:SUITE 1260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2728
Mailing Address - Country:US
Mailing Address - Phone:713-797-0466
Mailing Address - Fax:713-797-0451
Practice Address - Street 1:6560 FANNIN
Practice Address - Street 2:STE 1260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-797-0466
Practice Address - Fax:713-797-0451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6316207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038223602Medicaid
8F5198Medicare PIN
TXG90359Medicare UPIN