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General NPI Number Information
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NPI Number | 1174076210
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Entity Type | Organization
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Legal Business Name | BAXTER PLASTIC SURGERY
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 6100 219TH ST SW SUITE 290
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2222
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Country | US
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Telephone | 425-776-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 219TH ST SW SUITE 290
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2222
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Country | US
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Telephone | 425-776-0880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ALAN BAXTER
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Credential | M.D.
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Telephone | 425-776-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | MD00022150
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License Number State | WA
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