Provider Demographics
NPI:1205843786
Name:BALDWIN, LARRY (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:BALDWIN
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 1:234 HEATHER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-8765
Mailing Address - Country:US
Mailing Address - Phone:805-434-5970
Mailing Address - Fax:805-434-5973
Practice Address - Street 1:689 TANK FARM RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7077
Practice Address - Country:US
Practice Address - Phone:805-781-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G649190Medicaid
CA180023850Medicare ID - Type UnspecifiedRR MEDICARE
CA00G649190Medicaid
CAWG64919CMedicare ID - Type Unspecified
CAWG64919BMedicare ID - Type Unspecified