1831192525 NPI number — DR. JOHN L BAEKE M.D.

Table of content: DR. JOHN L BAEKE M.D. (NPI 1831192525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192525 NPI number — DR. JOHN L BAEKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAEKE
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831192525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
05/31/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 DI LUSSO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-380-2525
Provider Business Mailing Address Fax Number:
530-430-2026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 TREELINE PARK STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-2079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-380-2525
Provider Business Practice Location Address Fax Number:
530-430-2026
Provider Enumeration Date:
05/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  T2821 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208200000X , with the licence number: G55894 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 04-24238 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 458239 . This is a "BCBS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 240003786 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 18537060 . This is a "BCBS OF KC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".