Provider Demographics
NPI:1902098304
Name:GARY L BAKER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GARY L BAKER MD A PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-408-4636
Mailing Address - Street 1:5750 DOWNEY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1480
Mailing Address - Country:US
Mailing Address - Phone:562-408-4636
Mailing Address - Fax:562-408-2684
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1405
Practice Address - Country:US
Practice Address - Phone:562-408-4636
Practice Address - Fax:562-408-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19147OtherMEDICARE GROUP NUMBER
CADO480AOtherOTHER MEDICARE GROUP NUMBER