Organization
PAUL J BAXLEY, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JAMIE J KRTICKA (OFFICE MANAGER)
(501) 315-4008
Entity
Organization
Contact information
Practice address
1000 HIGHWAY 35 N STE 8, BENTON, AR 72019-2353
(501) 315-4008
(501) 315-3411
Mailing address
1000 HIGHWAY 35 N STE 8, P. O. BOX 2860, BENTON, AR 72019-2353
(501) 315-4008
(501) 315-3411
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C4798
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104490001
—
AR
01
—
1164414462
INDIV-NPI #
AR
01
—
5G997
MEDICARE-GROUP
AR
Enumeration date
03/14/2007
Last updated
05/25/2016
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