Provider Demographics
NPI:1134218977
Name:BAKER, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1624 SOUTH I STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5093
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-383-3376
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE 304
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3078
Practice Address - Country:US
Practice Address - Phone:253-983-1977
Practice Address - Fax:253-983-1976
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-08-01
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Provider Licenses
StateLicense IDTaxonomies
WAMD00019694207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043223Medicaid
WAAB04765Medicare ID - Type UnspecifiedMEDICARE
WAA06421Medicare UPIN