Healthcare Provider Details

I. General information

NPI: 1477691061
Provider Name (Legal Business Name): PAUL BAXT M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 HOLMBERG RD APT 316
PARKLAND FL
33067-4521
US

IV. Provider business mailing address

5851 HOLMBERG RD APT 316
PARKLAND FL
33067-4521
US

V. Phone/Fax

Practice location:
  • Phone: 917-796-0355
  • Fax:
Mailing address:
  • Phone: 917-796-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME14909
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19409
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number50477
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: