MEDICARE: DR. JEFFREY BALDRIDGE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	25162	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25162	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1144834268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BALDRIDGE PH.D.

Provider Business Mailing Address
First Line	:	8140 WALNUT HILL LN STE 450
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	214-265-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LN STE 450
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	214-265-1965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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