Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD074179L | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD074179L | PA |
NPI | 1093731184 |
---|---|
Provider Name | Dr. Jason Baxter |
First Address | Philadelphia, PA 19107-5127 |
Second Address | Philadelphia, PA 19107-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 28/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072184 | (05) | NJ |
101346451 | (05) | PA |