Individual
MR. WYATT DALE BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
(319) 768-1000
Mailing address
1393 N COUNTY ROAD 3000, TENNESSEE, IL 62374-3037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
079496
IA
Other
Enumeration date
08/25/2015
Last updated
08/25/2015
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