Provider Demographics
NPI:1659465250
Name:BELL, BAXTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAXTER
Middle Name:
Last Name:BELL
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 1:426 41ST ST
Mailing Address - Street 2:#3
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2579
Mailing Address - Country:US
Mailing Address - Phone:510-681-4161
Mailing Address - Fax:
Practice Address - Street 1:616 PETALUMA BLVD N
Practice Address - Street 2:SUITE C
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2847
Practice Address - Country:US
Practice Address - Phone:707-778-3171
Practice Address - Fax:707-778-6744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG085503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine