Basic Information
| Provider Information | |||||||||
| NPI: | 1134291883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 E BOCKMAN WAY | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385832041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318366461 | ||||||||
| FaxNumber: | 9318368471 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 E BOCKMAN WAY | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385832041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318366461 | ||||||||
| FaxNumber: | 9318368471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 12/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD0000019683 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3044975 | 05 | TN | MEDICAID |