Provider Demographics
NPI:1114136983
Name:BYRON DAVID BALDRIDGE
Entity Type:Organization
Organization Name:BYRON DAVID BALDRIDGE
Other - Org Name:DAVID BALDRIDGE, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-727-1131
Mailing Address - Street 1:2300 12TH AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5017
Mailing Address - Country:US
Mailing Address - Phone:406-727-1131
Mailing Address - Fax:
Practice Address - Street 1:2300 12TH AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5017
Practice Address - Country:US
Practice Address - Phone:406-727-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4902207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0071422Medicaid
MTE32856Medicare UPIN
MT00001791Medicare ID - Type Unspecified