Provider Demographics
NPI:1851339014
Name:BAKER, KEITH A (DO)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
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 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9771
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:
Practice Address - Street 1:316 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1710
Practice Address - Country:US
Practice Address - Phone:239-226-2650
Practice Address - Fax:239-458-0899
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022489500Medicaid
FL82651VOtherMEDICARE
FL82651OtherBLUE CROSS PROVIDER
FL234150OtherAVMED PROVIDER #
NY482723OtherBC/BS HIGHMARK
P2267004OtherOXFORD
NY482723OtherBC/BS HIGHMARK