Individual
BLAISE W BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 VAN NESS AVE, SAN FRANCISCO, CA 94109-6978
(415) 600-7887
(415) 369-1395
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(415) 600-7887
(415) 369-1395
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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