Provider Demographics
NPI:1649220450
Name:BAXTER, BRIAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:1326 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5025
Practice Address - Country:US
Practice Address - Phone:419-625-0654
Practice Address - Fax:419-621-1276
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0918565Medicaid
OH080171555OtherMEDICARE RAILROAD
OH0918565Medicaid
OH080171555OtherMEDICARE RAILROAD