=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659465250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAXTER BELL JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 PETALUMA BLVD N SUITE C
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-778-3171
-----------------------------------------------------
Fax | 707-778-6744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 426 41ST ST #3
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-2579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-681-4161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G085503
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------