Jonathan C Baker, M.D.
Individual provider Active NPI Pediatrics Physician · Tulsa, OK
NPI 1912969338 · NPPES record last updated Jan 20, 2017
Key facts
- NPI
- 1912969338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 15100 (OK)
- Practice address
- Riverside Pediatrics
9659 Riverside Dr
Tulsa, OK 74137-7305 - Phone
- (918) 299-5040
- Fax
- (918) 299-9041
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15100 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empower Pediatrics | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 15100 | OK | Yes |
Addresses
Primary practice location
Riverside Pediatrics
9659 Riverside Dr
Tulsa, OK 74137-7305
Mailing address
Riverside Pediatrics
9659 Riverside Dr
Tulsa, OK 74137-7305
Phone (918) 299-5040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100123970A | Medicaid | OK |
Other providers in Tulsa, OK
- Jana Nicole Baker
- Jazmin Matlock Baker
- Jessica Baker
- Joan E. Baker
- Jodie Leeann Baker
- Joshua Ryan Baker
- Katlyn Baker
- Kelli Michelle Baker
- Larry Allen Baker
- Lashawn Denise Baker
All providers in Tulsa, OK · Pediatrics Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.