Basic Information
| Provider Information | |||||||||
| NPI: | 1992793293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17000 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729177000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793144000 | ||||||||
| FaxNumber: | 4793144050 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 FAYETTEVILLE RD | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729566523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793144000 | ||||||||
| FaxNumber: | 4793144050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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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 | R4408 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 122045003 | 05 | AR | MEDICAID | 100200680D | 05 | OK | MEDICAID |