Provider Demographics
NPI:1629231725
Name:BAXTER, TREY HERRON
Entity Type:Individual
Prefix:MR
First Name:TREY
Middle Name:HERRON
Last Name:BAXTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BERKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3826
Mailing Address - Country:US
Mailing Address - Phone:601-941-2023
Mailing Address - Fax:601-922-5281
Practice Address - Street 1:580 SPRINGRIDGE RD
Practice Address - Street 2:A5
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5671
Practice Address - Country:US
Practice Address - Phone:601-941-2023
Practice Address - Fax:601-922-5281
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies