Provider Demographics
NPI:1790219079
Name:BAKER, OMAR FAROUK (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:FAROUK
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678253
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8253
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-1102
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:800-841-4236
Practice Address - Fax:706-653-1230
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00680892085R0202X, 2085R0202X
TXU16392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology