Provider Demographics
NPI:1346125788
Name:BAKER, BRETT
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W SOUTHERN AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5027
Mailing Address - Country:US
Mailing Address - Phone:480-833-5007
Mailing Address - Fax:
Practice Address - Street 1:525 W SOUTHERN AVE STE 124
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5027
Practice Address - Country:US
Practice Address - Phone:480-833-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist