Provider Demographics
NPI:1255384988
Name:BALDWIN, JONATHAN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARTIN
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-250-2033
Mailing Address - Fax:918-392-4465
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 385
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-250-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21802207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102610BMedicaid
OK800522535OtherMEDICARE GROUP PIN
OKH87088Medicare UPIN
OK100102610BMedicaid