Provider Demographics
NPI:1932364692
Name:BRADLEY S BAKER MD PLLC
Entity Type:Organization
Organization Name:BRADLEY S BAKER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-324-0449
Mailing Address - Street 1:1928 E HIGHLAND AVENUE
Mailing Address - Street 2:F104-501
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4636
Mailing Address - Country:US
Mailing Address - Phone:602-324-0449
Mailing Address - Fax:602-266-4477
Practice Address - Street 1:9327 N 3RD STREET
Practice Address - Street 2:STE. 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2473
Practice Address - Country:US
Practice Address - Phone:602-324-0449
Practice Address - Fax:602-266-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54918Medicare UPIN