Individual
DR. CHARLES EDWARD BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5640
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022421
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669776
—
LA
01
—
254903YH54
MEDICARE - PTAN
LA
Enumeration date
10/24/2006
Last updated
07/31/2014
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