Basic Information
| Provider Information | |||||||||
| NPI: | 1831145622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4045 E BELL RD | ||||||||
| Address2: | STE #143 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028670404 | ||||||||
| FaxNumber: | 6027880893 | ||||||||
| Practice Location | |||||||||
| Address1: | 4045 E BELL RD | ||||||||
| Address2: | STE #143 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028670404 | ||||||||
| FaxNumber: | 6027880893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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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 | 2085R0202X | 33732 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 975162 | 05 | AZ | MEDICAID | AZ0153720 | 01 | AS | BLUE CROSS BLUE SHIELD | OTHER |