Provider Demographics
NPI:1558404905
Name:VERNON T. BALDWIN, M.D.,P.C.
Entity Type:Organization
Organization Name:VERNON T. BALDWIN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-435-4084
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-0430
Mailing Address - Country:US
Mailing Address - Phone:318-435-4084
Mailing Address - Fax:318-435-9260
Practice Address - Street 1:2104 LOOP RD
Practice Address - Street 2:SUITE E
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3338
Practice Address - Country:US
Practice Address - Phone:318-435-4084
Practice Address - Fax:318-435-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6952261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1003191Medicaid
LAB60286Medicare UPIN
LA5J064Medicare ID - Type Unspecified