Provider Demographics
NPI:1154454940
Name:BAXTER, MAUREEN O'BRIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:O'BRIEN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:THERESA
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25184
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0184
Mailing Address - Country:US
Mailing Address - Phone:503-292-9108
Mailing Address - Fax:503-292-0346
Practice Address - Street 1:9205 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6603
Practice Address - Country:US
Practice Address - Phone:503-216-4830
Practice Address - Fax:503-216-4850
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD272572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology