Provider Demographics
NPI:1801874698
Name:BAKER, TODD F (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:F
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32600
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-2600
Mailing Address - Country:US
Mailing Address - Phone:318-212-4877
Mailing Address - Fax:318-212-4192
Practice Address - Street 1:620 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2926
Practice Address - Country:US
Practice Address - Phone:870-365-2000
Practice Address - Fax:318-212-7505
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15526R207P00000X
ARE-3581207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190608001Medicaid
5H828OtherAR BLUE CROSS
LA1465160Medicaid
5H828OtherAR BLUE CROSS