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Individual
BLAISE W BAXTER
Active
Individual
BLAISE W BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
31416
TN
2085R0202X
Diagnostic Radiology Physician
C171504
CA
2085R0204X
Vascular & Interventional Radiology Physician
MD19382
RI
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD468416
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C171504
STATE MEDICAL LICENSE
CA
Enumeration date
06/27/2006
Last updated
07/07/2023
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