Provider Demographics
NPI:1568561025
Name:STUTTS, BALDWIN S III (MD)
Entity Type:Individual
Prefix:DR
First Name:BALDWIN
Middle Name:S
Last Name:STUTTS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:SHIELDS
Other - Last Name:STUTTS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:802 AINSWORTH DR
Mailing Address - Street 2:SIOTE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1623
Mailing Address - Country:US
Mailing Address - Phone:928-445-6025
Mailing Address - Fax:928-778-3026
Practice Address - Street 1:802 AINSWORTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1623
Practice Address - Country:US
Practice Address - Phone:928-445-6025
Practice Address - Fax:928-778-3026
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35954207RC0000X
IDM-5171207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ263405Medicaid
AZC22387Medicare UPIN
AZZ126374Medicare PIN