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General NPI Number Information
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NPI Number | 1538371679
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Entity Type | Individual
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Provider Name | ZACHERY CHAD BAXTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 1260 15TH ST STE 1200
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-451-8751
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Fax | 310-394-5302
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | A103187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A103187
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License Number State | CA
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