Healthcare Provider Details

I. General information

NPI: 1033160254
Provider Name (Legal Business Name): BAXTER MCLENDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 REVOLUTIONARY TRL
FAIRFAX SC
29827-7109
US

IV. Provider business mailing address

PO BOX 599
BRUNSON SC
29911-0599
US

V. Phone/Fax

Practice location:
  • Phone: 803-632-2533
  • Fax: 803-632-2451
Mailing address:
  • Phone: 803-632-1699
  • Fax: 803-632-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number6266
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number6266
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: