Provider Demographics
NPI:1548246226
Name:BAKER, JANICE KAYE (DO)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:KAYE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:KAYE
Other - Last Name:TABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2441
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-2441
Mailing Address - Country:US
Mailing Address - Phone:563-324-8160
Mailing Address - Fax:563-324-8486
Practice Address - Street 1:3705 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1655
Practice Address - Country:US
Practice Address - Phone:563-324-8160
Practice Address - Fax:563-324-8486
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02219207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0043323Medicaid
A03537Medicare UPIN
IA0043323Medicaid