Individual
ROBERT ELLIS BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
111 W BROADWAY AVE, BROKEN ARROW, OK 74012-3814
(918) 258-5656
(918) 258-8722
Mailing address
111 W BROADWAY AVE, BROKEN ARROW, OK 74012-3814
(918) 258-5656
(918) 258-8722
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
1591
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087290A
—
OK
05
—
100087290C
—
OK
Enumeration date
03/10/2006
Last updated
07/08/2007
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