Provider Demographics
NPI:1366586885
Name:BAKER, BRIAN PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17230 JACKSON CREEK PKWY
Mailing Address - Street 2:#300
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7301
Mailing Address - Country:US
Mailing Address - Phone:719-571-7000
Mailing Address - Fax:719-571-7059
Practice Address - Street 1:17230 JACKSON CREEK PKWY
Practice Address - Street 2:#300
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7301
Practice Address - Country:US
Practice Address - Phone:719-571-7000
Practice Address - Fax:719-571-7059
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COTL0004851207Q00000X
CODR.0056145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health