Provider Demographics
NPI:1912134081
Name:R A BEXTON MD, INC
Entity Type:Organization
Organization Name:R A BEXTON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-829-5939
Mailing Address - Street 1:PO BOX 20553
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0553
Mailing Address - Country:US
Mailing Address - Phone:661-829-5939
Mailing Address - Fax:661-679-7956
Practice Address - Street 1:4939 CALLOWAY DR STE 102
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-9721
Practice Address - Country:US
Practice Address - Phone:661-829-5939
Practice Address - Fax:661-679-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508829250OtherINDIVIDUAL NPI
CADP0556OtherRR MCRE GROUP PTAN
CA00A440130Medicaid
CAP00726023OtherRR MCRE INDIVIDUAL PTAN
CAP00726023OtherRR MCRE INDIVIDUAL PTAN
CA00A440130Medicaid