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General NPI Number Information
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NPI Number | 1629231725
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Entity Type | Individual
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Provider Name | MR. TREY HERRON BAXTER
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Gender | Male
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 580 SPRINGRIDGE RD A5
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City | CLINTON
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State | MS
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Zip | 39056-5671
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Country | US
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Telephone | 601-941-2023
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Fax | 601-922-5281
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Provider Business Mailing Address
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Address Line | 507 BERKSHIRE ST
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City | CLINTON
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State | MS
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Zip | 39056-3826
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Country | US
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Telephone | 601-941-2023
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Fax | 601-922-5281
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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