Provider Demographics
NPI:1932158953
Name:BAKER, ALEC (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 596
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6640
Practice Address - Country:US
Practice Address - Phone:503-216-8670
Practice Address - Fax:503-216-8699
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00402363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500604193Medicaid
ORP01193161OtherRR MEDICARE - PROVIDENCE
ORR163969Medicare PIN
R99110Medicare UPIN
OR088WCGDTBMedicare UPIN