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General NPI Number Information
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NPI Number | 1023048907
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Entity Type | Organization
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Legal Business Name | GENERATIONS FAMILY MEDICINE PC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 1035 BELLEVUE AVE SUITE 206
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City | ST LOUIS
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State | MO
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Zip | 63117-1846
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Country | US
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Telephone | 314-781-4922
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Fax | 314-645-0158
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Provider Business Mailing Address
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Address Line | 1035 BELLEVUE AVE SUITE 206
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City | ST LOUIS
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State | MO
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Zip | 63117-1846
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Country | US
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Telephone | 314-781-4922
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Fax | 314-645-0158
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA A BAXTER
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Credential | M.D.
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Telephone | 314-781-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000154561
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License Number State | MO
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