Provider Demographics
NPI:1821063942
Name:BAKER, HOWARD A III (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:BAKER
Suffix:III
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 348
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-0348
Mailing Address - Country:US
Mailing Address - Phone:904-810-1045
Mailing Address - Fax:904-810-1046
Practice Address - Street 1:300 HEALTHPARK BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-810-1045
Practice Address - Fax:904-810-1046
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45744207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0636515100Medicaid
FLP00429786OtherRAILROAD MEDICARE
FL10335AMedicare PIN
FLP00429786OtherRAILROAD MEDICARE