MEDICARE: KEVIN BAXTER DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO24314	CA
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1508047226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN BAXTER DO PC

Provider Business Mailing Address
First Line	:	PO BOX 450
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-0450
Country	:	US
Telephone Number	:	503-741-3570
Fax Number	:	503-741-3569

Provider Business Practice Location Address
First Line	:	10 PIER 1 STE 301
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-6338
Country	:	US
Telephone Number	:	503-741-3570
Fax Number	:	503-741-3569

Authorized Official
Title or Position	:	CORPORATE SECRETARY
Name	:	JACKILYN BAXTER
Credential	:
Telephone Number	:	503-741-3570

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	02/12/2021

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Directions to “KEVIN BAXTER DO PC ” Practice Location

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