Provider Demographics
NPI:1265693386
Name:BAKER, BRIDGETTE MARIE (MD)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:MARIE
Other - Last Name:LATIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8950 W EMERALD ST #195
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-999-3034
Mailing Address - Fax:208-576-4201
Practice Address - Street 1:8950 W EMERALD ST #195
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-999-3034
Practice Address - Fax:208-576-4201
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10880207Q00000X
IDMR-0991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808082500Medicaid