Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E1735 | CA |
N | 222Z00000X | Podiatrist | E1735 | CA |
Y | 213EP1101X | Primary Podiatric Medicine | E1735 | CA |
N | 111NR0200X | Radiology | E1735 | CA |
N | 213ER0200X | Radiology | E1735 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E1735 | CA |
NPI | 1316151590 |
---|---|
Provider Name | Gerald G Baker |
First Address | Santa Monica, CA 90404-1135 |
Second Address | Santa Monica, CA 90404-1135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 18/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0207250001 | MEDICARE DME (01) | CA |
1043245525 | GROUP NPI (01) | CA |
E1735 | STATE LICENSE NUMBER (01) | CA |
U05100 | (02) | CA |
WE6504 | MEDICARE GROUP NUMBER (01) | CA |