Provider Demographics
NPI:1871555425
Name:BAKER, PHILIP ALAN (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALAN
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1822
Practice Address - Country:US
Practice Address - Phone:530-243-1249
Practice Address - Fax:530-243-3544
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG874682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777568Medicaid
AZ777568Medicaid
AZ777568Medicaid