Provider Demographics
NPI:1245254739
Name:BAKER, THOMAS J (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 E 3075 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1886
Mailing Address - Country:US
Mailing Address - Phone:801-782-9367
Mailing Address - Fax:
Practice Address - Street 1:2850 NORTH 2000 WEST
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9264
Practice Address - Country:US
Practice Address - Phone:801-731-1222
Practice Address - Fax:801-731-1666
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5955488-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00699150Medicare PIN
UT000065236Medicare PIN
UT005777002Medicare PIN