Basic Information
| Provider Information | |||||||||
| NPI: | 1912922964 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAKER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 16TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063263000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 16TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063263000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10004489 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 2085R0202X | PA10004489 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0375582 | 01 | WA | L&I-UNION AVE OPEN MRI | OTHER | 1093156 | 05 | WA | MEDICAID | 0226688 | 01 | WA | L&I-TRA REST OF WA | OTHER | 0395156 | 01 | WA | L&I-DIAGNOSTIC IMAGING NW | OTHER |