Provider Demographics
NPI:1295917730
Name:DAN R BAKER, MD, PA
Entity type:Organization
Organization Name:DAN R BAKER, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-496-0394
Mailing Address - Street 1:402 W PALM VALLEY BLVD STE A123
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4200
Mailing Address - Country:US
Mailing Address - Phone:512-496-0394
Mailing Address - Fax:512-249-1719
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5094
Practice Address - Country:US
Practice Address - Phone:512-496-0394
Practice Address - Fax:512-249-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXF3729207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001EVOtherBCBS
TX0001EVOtherBCBS
TX079560101Medicaid