Provider Demographics
NPI:1831192525
Name:BAEKE, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BAEKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DI LUSSO DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-4703
Mailing Address - Country:US
Mailing Address - Phone:918-380-2525
Mailing Address - Fax:530-430-2026
Practice Address - Street 1:423 TREELINE PARK STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2079
Practice Address - Country:US
Practice Address - Phone:918-380-2525
Practice Address - Fax:530-430-2026
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2025-03-18
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2018-05-31
Provider Licenses
StateLicense IDTaxonomies
CAG55894208200000X
TXT2821208D00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS18537060OtherBCBS OF KC
KS240003786OtherRAILROAD MEDICARE
KS458239OtherBCBS OF KS