Provider Demographics
NPI:1720073596
Name:BALDRIDGE, BYRON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:DAVID
Last Name:BALDRIDGE
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 1:7300 RANCH ROAD 2222
Mailing Address - Street 2:BUILDING 1, STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:512-628-0465
Mailing Address - Fax:512-628-0468
Practice Address - Street 1:1 MEDICAL PARK DR # 201B
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8022
Practice Address - Country:US
Practice Address - Phone:406-443-7200
Practice Address - Fax:406-443-7201
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4902207NS0135X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT070000634OtherRAILROAD MEDICARE
MT0071422Medicaid
E32856Medicare UPIN
MT0071422Medicaid