Provider Demographics
NPI:1730181223
Name:BAKER, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
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 1:1809 BRENNER AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144
Mailing Address - Country:US
Mailing Address - Phone:704-636-4646
Mailing Address - Fax:704-636-4447
Practice Address - Street 1:1809 BRENNER AVE
Practice Address - Street 2:STE 102
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-636-4646
Practice Address - Fax:704-636-4447
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900416207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891226WMedicaid
NC2271592DMedicare ID - Type Unspecified
G89487Medicare UPIN