Provider Demographics
NPI:1487656104
Name:BALDINGER, PHILIP J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:BALDINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1335
Mailing Address - Country:US
Mailing Address - Phone:941-758-8818
Mailing Address - Fax:941-755-2901
Practice Address - Street 1:1800 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1335
Practice Address - Country:US
Practice Address - Phone:941-758-8818
Practice Address - Fax:941-755-2901
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO8041213E00000X
FLPO2417213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480018371OtherRR INDIVIDUAL PROV. #
FL65375ZMedicare PIN
FL480018371OtherRR INDIVIDUAL PROV. #