Healthcare Provider Details

I. General information

NPI: 1487711909
Provider Name (Legal Business Name): CLARKE WILLIAM BAXTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HERRICK RD
SOUTHWEST HARBOR ME
04679-4433
US

IV. Provider business mailing address

4760 RED BANK RD STE 104
CINCINNATI OH
45227-1549
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5513
  • Fax: 207-664-5515
Mailing address:
  • Phone: 513-271-4488
  • Fax: 513-271-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35053662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: