MEDICARE: RICK BAXLEY M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 48761	FL

General Provider Information

NPI Number	:	1942384771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICK BAXLEY M.D., P.A.

Provider Business Mailing Address
First Line	:	2629 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4459
Country	:	US
Telephone Number	:	407-246-7001
Fax Number	:	407-246-7009

Provider Business Practice Location Address
First Line	:	2629 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4459
Country	:	US
Telephone Number	:	407-246-7001
Fax Number	:	407-246-7009

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KONNIE KAY COHRS
Credential	:
Telephone Number	:	407-246-7001

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/02/2014

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