Provider Demographics
NPI:1649466459
Name:BAKER, RUSSELL ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ANDREW
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 1:772 BITTERSWEET PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2002
Mailing Address - Country:US
Mailing Address - Phone:575-571-2931
Mailing Address - Fax:
Practice Address - Street 1:772 BITTERSWEET PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-2002
Practice Address - Country:US
Practice Address - Phone:575-571-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0025744207P00000X
TXM9143207P00000X
NMA144908390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW498OtherBCBS
TX202772401Medicaid
TXP00802542OtherRAILROAD
TX202772401Medicaid