Provider Demographics
NPI:1770544959
Name:BAKER, JEFFREY RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 DORMAN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5123
Mailing Address - Country:US
Mailing Address - Phone:479-756-3251
Mailing Address - Fax:479-756-9186
Practice Address - Street 1:900 DORMAN ST
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5123
Practice Address - Country:US
Practice Address - Phone:479-756-3251
Practice Address - Fax:479-756-9186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine