Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 25903 | AL |
NPI | 1104858067 |
---|---|
Provider Name | George Baxter |
First Address | Mobile, AL 36616-0725 |
Second Address | Mobile, AL 36607-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00993549 | (05) | AL |
009935911 | (05) | AL |
009935912 | (05) | AL |
009935913 | (05) | AL |
51533486 | BLUE CROSS (01) | AL |
51533488 | BLUE CROSS (01) | AL |
51533489 | BLUE CROSS (01) | AL |
51533490 | BLUE CROSS (01) | AL |
I21533 | (02) | AL |