Provider Demographics
NPI:1356382956
Name:BAXTER, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG535942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G535943Medicare PIN
CA00G535944Medicare PIN
CA00G535946Medicare PIN
CA00G535947Medicare PIN
CA300125270Medicare PIN
CA00G5359417Medicare PIN
CA00G5359422Medicare PIN
CA00G5359410Medicare PIN
CA00G5359413Medicare PIN
CAE20579Medicare UPIN
CA00G5359412Medicare PIN
CA00G5359414Medicare PIN
CA00G5359418Medicare PIN
CA300114501Medicare PIN
CA00G5359415Medicare PIN
CA00G5359416Medicare PIN
CA00G535948Medicare PIN
CA00G5359411Medicare PIN
CA00G5359420Medicare PIN
CA00G5359419Medicare PIN
CA00G5359421Medicare PIN
CA00G535945Medicare PIN
CA00G535949Medicare PIN
CA00G535940Medicare PIN