Provider Demographics
NPI:1215661541
Name:BAXTER, WILLIAM ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALLEN
Last Name:BAXTER
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:146 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9493
Mailing Address - Country:US
Mailing Address - Phone:731-693-0499
Mailing Address - Fax:
Practice Address - Street 1:461 E TEN MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9712
Practice Address - Country:US
Practice Address - Phone:731-693-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-10-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant