Provider Demographics
NPI:1134342413
Name:BAXTER, SEAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:BAXTER
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 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-589-8700
Practice Address - Fax:253-581-6588
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048134207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0221502OtherLIWA
WA4416BAOtherBSWA
WA6689BAOtherBSWA
WA8483562Medicaid
WA0221501OtherLIWA
WA0221503OtherLIWA
WA5449BAOtherBSWA
WA0221502OtherLIWA
WA6689BAOtherBSWA