Provider Demographics
NPI:1205987666
Name:BAKER, JOHN C (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
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 1:1978 MILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-9793
Mailing Address - Country:US
Mailing Address - Phone:330-872-1336
Mailing Address - Fax:
Practice Address - Street 1:1978 MILTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9793
Practice Address - Country:US
Practice Address - Phone:330-872-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0535531Medicaid
BA0481111Medicare ID - Type Unspecified
CO1887Medicare UPIN