Healthcare Provider Details

I. General information

NPI: 1811121981
Provider Name (Legal Business Name): PATRICIA A BAXTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST CC1410.00
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

PO BOX 4769
HOUSTON TX
77210-4769
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-4200
  • Fax:
Mailing address:
  • Phone: 832-828-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberN1258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: