Tracy M Baker, MD

Individual provider Active NPI Family Medicine Physician · Stigler, OK

NPI 1639101488 · NPPES record last updated Jan 2, 2014

Key facts

NPI
1639101488
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
26593 (OK)
Practice address
1505 E Main St
Stigler, OK 74462-2913
Phone
(918) 967-3368
Fax
(917) 967-3351
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25080KSMDFamily Medicine Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25080 KS
Family Medicine Physician 207Q00000X 26593 OK Yes

Addresses

Primary practice location

1505 E Main St
Stigler, OK 74462-2913

Mailing address

PO Box 179
Stigler, OK 74462-0179
Phone (918) 967-4560

Other identifiers

IdentifierTypeStateIssuer
16936OtherKSCOVENTRY
4253OtherKSPHS
047743OtherKSBCBS
200205450AMedicaidOK
11001972OtherKSMULTIPLAN
100659OtherKSHPK

Other providers in Stigler, OK

All providers in Stigler, OK · Family Medicine Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.