Provider Demographics
NPI:1720035637
Name:BAXTER, BARBARA J STARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J STARK
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:STARK
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6114 SHERRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6301
Mailing Address - Country:US
Mailing Address - Phone:214-363-8653
Mailing Address - Fax:214-368-4384
Practice Address - Street 1:6114 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6301
Practice Address - Country:US
Practice Address - Phone:214-363-8653
Practice Address - Fax:214-368-4384
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7931207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GV29Medicare PIN
TXB26661Medicare UPIN