Provider Demographics
NPI:1144554551
Name:BAXTER-BUBEL, PATRICIA
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:BAXTER-BUBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N. AVE B
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-3227
Mailing Address - Country:US
Mailing Address - Phone:254-486-2162
Mailing Address - Fax:254-486-9298
Practice Address - Street 1:140 N. AVE B
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-3227
Practice Address - Country:US
Practice Address - Phone:254-486-2162
Practice Address - Fax:254-486-9298
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10794332S00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144554551OtherEIN