1154454940 NPI number — DR. MAUREEN O'BRIEN BAXTER M.D.

Table of content: DR. MAUREEN O'BRIEN BAXTER M.D. (NPI 1154454940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154454940 NPI number — DR. MAUREEN O'BRIEN BAXTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
MAUREEN
Provider Middle Name:
O'BRIEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'BRIEN
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154454940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97298-0184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-292-9108
Provider Business Mailing Address Fax Number:
503-292-0346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9205 SW BARNES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-216-4830
Provider Business Practice Location Address Fax Number:
503-216-4850
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD27257 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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