Provider Demographics
NPI:1942384771
Name:RICK BAXLEY M.D., P.A.
Entity Type:Organization
Organization Name:RICK BAXLEY M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KONNIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-246-7001
Mailing Address - Street 1:2629 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4459
Mailing Address - Country:US
Mailing Address - Phone:407-246-7001
Mailing Address - Fax:407-246-7009
Practice Address - Street 1:2629 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4459
Practice Address - Country:US
Practice Address - Phone:407-246-7001
Practice Address - Fax:407-246-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 48761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty