Provider Demographics
NPI:1730335753
Name:BAKER, SARAH GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GRACE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3910
Mailing Address - Country:US
Mailing Address - Phone:318-221-2623
Mailing Address - Fax:318-424-9850
Practice Address - Street 1:2300 HOSPITAL DR STE 400
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2166
Practice Address - Country:US
Practice Address - Phone:318-212-7800
Practice Address - Fax:318-212-7805
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054581208600000X
LAMD.206040207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208600000XAllopathic & Osteopathic PhysiciansSurgery