Provider Demographics
NPI:1710036918
Name:BALDWIN, DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ISLETA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3896
Mailing Address - Country:US
Mailing Address - Phone:505-242-9550
Mailing Address - Fax:505-247-8950
Practice Address - Street 1:111 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3896
Practice Address - Country:US
Practice Address - Phone:505-242-9550
Practice Address - Fax:505-247-8950
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2006-0033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant