Provider Demographics
NPI:1306934351
Name:BAXTER, JEREMEY D (AA)
Entity type:Individual
Prefix:
First Name:JEREMEY
Middle Name:D
Last Name:BAXTER
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-1999
Practice Address - Fax:972-233-3666
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA728OtherA A CERTICATE #
TX337610502Medicaid
TX338375YK6UMedicare PIN
TX8J3430Medicare PIN