Individual
DR. KENNETH C BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N PARK ST, BRENHAM, TX 77833
(979) 836-6153
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
(254) 215-9722
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
F3730
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10008791
AMERIGROUP
TX
05
—
100655303
—
TX
01
—
101821
SUPERIOR CHIPS
TX
01
—
4535342
AETNA
TX
Enumeration date
05/23/2005
Last updated
09/19/2018
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