Provider Demographics
NPI:1730167222
Name:BAKER, JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 N LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-3706
Mailing Address - Country:US
Mailing Address - Phone:850-258-4048
Mailing Address - Fax:850-236-6400
Practice Address - Street 1:5821 N LAGOON DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-3706
Practice Address - Country:US
Practice Address - Phone:850-258-4048
Practice Address - Fax:850-236-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0008280207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261024800Medicaid
FL58665OtherBCBS
FL930125555OtherRRMCR
FL58665WMedicare PIN
G45560Medicare UPIN
FL261024800Medicaid