Provider Demographics
NPI:1699853093
Name:BAXLEY, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BAXLEY
Suffix:
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 1:105 W 8TH AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2312
Mailing Address - Country:US
Mailing Address - Phone:509-838-6236
Mailing Address - Fax:509-838-3450
Practice Address - Street 1:105 W 8TH AVE STE 510
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2312
Practice Address - Country:US
Practice Address - Phone:509-838-6236
Practice Address - Fax:509-838-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000189472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0045633OtherLABOR AND INDUSTRIES
WAA0089Medicare UPIN
WA0045633OtherLABOR AND INDUSTRIES