Provider Demographics
NPI:1174693980
Name:BAKER, STACIA C (MD)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 I-70 BUSINESS LOOP STE A4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7687
Mailing Address - Country:US
Mailing Address - Phone:970-434-6542
Mailing Address - Fax:970-434-3327
Practice Address - Street 1:3225 I-70 BUSINESS LOOP STE A4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7687
Practice Address - Country:US
Practice Address - Phone:970-434-6542
Practice Address - Fax:970-434-3327
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87276542Medicaid
CO87276542Medicaid
COG26810Medicare UPIN