Healthcare Provider Details

I. General information

NPI: 1336113281
Provider Name (Legal Business Name): LEAH GENEVA BAXTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH GENEVA NEWMAN

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 E 91ST ST
TULSA OK
74133-6053
US

IV. Provider business mailing address

6528 E 101ST ST PMB 431 SUITE D1
TULSA OK
74133-6724
US

V. Phone/Fax

Practice location:
  • Phone: 918-895-7808
  • Fax: 918-895-7807
Mailing address:
  • Phone: 918-895-7808
  • Fax: 918-895-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4052
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: