Provider Demographics
NPI:1538273859
Name:BAKER, SHANE ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ARTHUR
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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 629
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-0629
Mailing Address - Country:US
Mailing Address - Phone:801-621-6671
Mailing Address - Fax:801-627-6679
Practice Address - Street 1:1303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-868-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308374-12052085R0202X
IN01051615A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132910Medicaid
IN443010MMedicare ID - Type Unspecified
IN281450KMedicare ID - Type Unspecified