Provider Demographics
NPI:1154327799
Name:BAXTER, JEFFREY JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57099
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7099
Mailing Address - Country:US
Mailing Address - Phone:281-485-0505
Mailing Address - Fax:281-485-0631
Practice Address - Street 1:3411 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4303
Practice Address - Country:US
Practice Address - Phone:281-485-0505
Practice Address - Fax:281-485-0631
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT382004213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007451609OtherAETNA PROVIDER ID
TX8M1222OtherBLUE CROSS BLUE SHIELD
TXP00244475OtherRAILROAD MEDICARE
TX178180901Medicaid
TX8M1222OtherBLUE CROSS BLUE SHIELD
TXP00244475OtherRAILROAD MEDICARE
TX8D3580Medicare PIN