Individual
KEVIN RAY BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
02004614A
IN
207W00000X
Ophthalmology Physician
510109282
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201292460
—
IN
01
—
204460004
MEDICARE PTAN
IN
Enumeration date
06/17/2011
Last updated
07/02/2015
Update your record
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