Provider Demographics
NPI:1902936271
Name:WILLIAM JOSEPH BAKER MD PLLC
Entity Type:Organization
Organization Name:WILLIAM JOSEPH BAKER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAINA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-272-9162
Mailing Address - Street 1:PO BOX 1884
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-1884
Mailing Address - Country:US
Mailing Address - Phone:580-272-9162
Mailing Address - Fax:580-272-9162
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-332-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19914207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106440BMedicaid
OK443545529002OtherBLUE CROSS BLUE SHIELD
OK050084626OtherRAILROAD MEDICARE
OK100106440BMedicaid
OK443545529PMedicare PIN