Provider Demographics
NPI:1851773485
Name:BAXTER, MARCUS ALLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ALLEN
Last Name:BAXTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:A
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2849 BARRON RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-9171
Practice Address - Country:US
Practice Address - Phone:979-207-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2344213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty