Provider Demographics
NPI:1750444972
Name:ROLA P BAKER MD PC
Entity Type:Organization
Organization Name:ROLA P BAKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-440-9128
Mailing Address - Street 1:2282 NW TROOST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6071
Mailing Address - Country:US
Mailing Address - Phone:541-440-9128
Mailing Address - Fax:541-440-9130
Practice Address - Street 1:2282 NW TROOST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6071
Practice Address - Country:US
Practice Address - Phone:541-440-9128
Practice Address - Fax:541-440-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR011119Medicaid
ORR0000BKBJVMedicare PIN
OR011119Medicaid