Healthcare Provider Details

I. General information

NPI: 1972863884
Provider Name (Legal Business Name): MICHAEL BAXTER M.D., MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 07/24/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

NMCSD 34520 BOB WILSON DR., SUITE 200
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-6646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC200023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: