Provider Demographics
NPI:1780699264
Name:BALDWIN-JOHNSON, CATHY (MD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BALDWIN-JOHNSON
Suffix:
Gender:F
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:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3925 TUDOR CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5931
Practice Address - Country:US
Practice Address - Phone:907-561-8301
Practice Address - Fax:907-561-8170
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1010986Medicaid
AK164083Medicare PIN
AKP01077836OtherRAILROAD MEDICARE PIN
AKMD1999Medicaid
AK150747Medicare PIN