Provider Demographics
NPI:1548380207
Name:BALDWIN, KENNETH H (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200W
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:214-775-4516
Practice Address - Street 1:4060 SANDSHELL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2422
Practice Address - Country:US
Practice Address - Phone:817-306-9777
Practice Address - Fax:817-306-9780
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD85012083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z957Medicare PIN
TX8L22920Medicare UPIN