Individual
DR. MARK C BAXTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
421 W STONE DR, SUITE 6, KINGSPORT, TN 37660-3269
(423) 245-4100
(423) 245-0463
Mailing address
421 W STONE DR, SUITE 6, KINGSPORT, TN 37660-3269
(423) 245-4100
(423) 245-0463
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
DPM0000000357
TN
213ES0131X
Foot Surgery Podiatrist
Primary
DPM0000000357
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093-2019-9
VA MEDICAID
VA
01
—
100010536
PHP
TN
01
—
216412
ANTHEM
VA
05
—
3351572
—
TN
01
—
480007576
UNITED HEALTH CARE RAIL R
TN
01
—
62-1402649
EMPLOYER IDENTIFICATION #
—
01
—
621402649
UNITED HEALTH CARE RIVER
TN
01
—
7510238
AETNA
TN
01
—
89548
BCBS OF TN
TN
Enumeration date
10/21/2005
Last updated
07/12/2013
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