Provider Demographics
NPI:1326136094
Name:BAXTER, JOHN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:129 E ST
Mailing Address - Street 2:SUITE E-4
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4658
Mailing Address - Country:US
Mailing Address - Phone:530-753-1309
Mailing Address - Fax:530-758-0864
Practice Address - Street 1:129 E ST
Practice Address - Street 2:SUITE E-4
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4658
Practice Address - Country:US
Practice Address - Phone:530-753-1309
Practice Address - Fax:530-758-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG352882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry