Provider Demographics
NPI:1154480689
Name:BAXTER, THOMAS LEROY III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEROY
Last Name:BAXTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1006
Mailing Address - Fax:713-790-2727
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-1006
Practice Address - Fax:713-790-2727
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF0869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00757544OtherMEDICARE RAILROAD
TX033036703Medicaid
TXP01030939OtherRR MEDICARE
TX33036702Medicaid
TX1154480689OtherBLUE CROSS BLUE SHIELD
TX033036703Medicaid
TX1154480689OtherBLUE CROSS BLUE SHIELD
TX33036702Medicaid
TXC13274Medicare UPIN