Provider Demographics
NPI:1871536151
Name:BAKER, MARK A (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 W PLANO PKWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1621
Mailing Address - Country:US
Mailing Address - Phone:972-395-7533
Mailing Address - Fax:972-395-7536
Practice Address - Street 1:6957 W PLANO PKWY STE 1100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1621
Practice Address - Country:US
Practice Address - Phone:972-395-7533
Practice Address - Fax:972-395-7536
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE62212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129139508Medicaid
TX129139510Medicaid
TX129139515Medicaid
TX204693003Medicaid
TX129139511Medicaid
D97186Medicare UPIN
TX129139510Medicaid
TX129139508Medicaid
TX8L12344Medicare PIN
TX8L12457Medicare PIN