Provider Demographics
NPI:1295966315
Name:BALDONADO, REGINALD PIUS Q (MD)
Entity type:Individual
Prefix:
First Name:REGINALD PIUS
Middle Name:Q
Last Name:BALDONADO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9145 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4820
Mailing Address - Country:US
Mailing Address - Phone:623-815-7800
Mailing Address - Fax:623-815-7900
Practice Address - Street 1:14873 W BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7609
Practice Address - Country:US
Practice Address - Phone:623-815-7800
Practice Address - Fax:623-815-7900
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2012-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ41409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ457980Medicaid