Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | DPM0000000357 | TN |
N | 222Z00000X | Podiatrist | DPM0000000357 | TN |
Y | 213ES0131X | Foot Surgery | DPM0000000357 | TN |
NPI | 1386634301 |
---|---|
Provider Name | Dr. Mark C Baxter |
First Address | Kingsport, TN 37660-3269 |
Second Address | Kingsport, TN 37660-3269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 12/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0093-2019-9 | VA MEDICAID (01) | VA |
100010536 | PHP (01) | TN |
216412 | ANTHEM (01) | VA |
3351572 | (05) | TN |
480007576 | UNITED HEALTH CARE RAIL R (01) | TN |
621402649 | UNITED HEALTH CARE RIVER (01) | TN |
62-1402649 | EMPLOYER IDENTIFICATION # (01) | |
7510238 | AETNA (01) | TN |
89548 | BCBS OF TN (01) | TN |
T81669 | (02) |