Provider Demographics
NPI:1851311351
Name:BAKER, JEFF (DPH)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HINDS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HEISKELL
Mailing Address - State:TN
Mailing Address - Zip Code:37754-3422
Mailing Address - Country:US
Mailing Address - Phone:865-494-3629
Mailing Address - Fax:
Practice Address - Street 1:990 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6976
Practice Address - Country:US
Practice Address - Phone:865-481-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist