Provider Demographics
NPI:1841295607
Name:BAKER, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2625 COFFEE RD
Mailing Address - Street 2:STE S
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2050
Mailing Address - Country:US
Mailing Address - Phone:208-577-1200
Mailing Address - Fax:209-577-6517
Practice Address - Street 1:2625 COFFEE RD
Practice Address - Street 2:STE S
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2050
Practice Address - Country:US
Practice Address - Phone:208-577-1200
Practice Address - Fax:209-577-6517
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27612207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27612OtherLICENSE
CAA43419Medicare UPIN
CA00G276120Medicare ID - Type Unspecified