1912297920 NPI number — DR. SILVIA GESHEVA BAXTER M.D.

Table of content: JESSICA PHAM (NPI 1174174007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912297920 NPI number — DR. SILVIA GESHEVA BAXTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
SILVIA
Provider Middle Name:
GESHEVA
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:
GESHEVA
Provider Other First Name:
SILVIA
Provider Other Middle Name:
IVANOVA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912297920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 SW ARCHER RD
Provider Second Line Business Mailing Address:
BOX 100265
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-9000
Provider Business Mailing Address Fax Number:
352-392-8413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 SW 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-6534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-401-8817
Provider Business Practice Location Address Fax Number:
352-401-8822
Provider Enumeration Date:
04/11/2011

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: 207T00000X , with the licence number:  DR.0070233 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 10804037-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: ME140852 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2150243 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000215953 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103839100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".