Provider Demographics
NPI:1275670481
Name:BAXTER, CHARLES F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:BAXTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMUSNAVCENT
Mailing Address - Street 2:PSC 451 CODE N014
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09501
Mailing Address - Country:BH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMUSNAVCENT
Practice Address - Street 2:PSC 451 CODE N014
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09501
Practice Address - Country:BH
Practice Address - Phone:318-439-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034821171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider