Provider Demographics
NPI:1922003235
Name:BAKER, BEN FOWLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:FOWLER
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 1:3400 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2407
Mailing Address - Country:US
Mailing Address - Phone:918-335-1515
Mailing Address - Fax:918-331-2519
Practice Address - Street 1:3400 E FRANK PHILLIPS BLVD
Practice Address - Street 2:STE 202
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2407
Practice Address - Country:US
Practice Address - Phone:918-335-1515
Practice Address - Fax:918-331-2519
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
OK12625207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34359Medicare UPIN