Provider Demographics
NPI:1376544726
Name:BAX, ALFRED JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:JAMES
Last Name:BAX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-8149
Mailing Address - Fax:716-298-1680
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:STE 101
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-297-8149
Practice Address - Fax:716-298-1680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1280761208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15452Medicare UPIN
021083Medicare ID - Type Unspecified