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Contact Information

MARK C BAXTER, DPM
421 W STONE DR
SUITE 6
KINGSPORT, TN37660-3269
 Phone: 423-245-4100
 Fax: 423-245-0463
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot

213ES0131X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARK C BAXTER · (Male)

NPI Number 1386634301
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 10/21/2005
Last updated 07/12/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • TN License # DPM0000000357
  • TN Medicaid 3351572
  • Other 62-1402649 EMPLOYER IDENTIFICATION #
  • TN Other 7510238 AETNA
  • TN Other 89548 BCBS OF TN
  • TN Other 100010536 PHP
  • TN Other 480007576 UNITED HEALTH CARE RAIL R
  • TN Other 621402649 UNITED HEALTH CARE RIVER
  • VA Other 216412 ANTHEM
  • VA Other 0093-2019-9 VA MEDICAID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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