Healthcare Provider Details

I. General information

NPI: 1245193101
Provider Name (Legal Business Name): JAMES BALDWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY BETHEL
BETHEL AK
99559-0528
US

IV. Provider business mailing address

PO BOX 528
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6000
  • Fax:
Mailing address:
  • Phone: 907-543-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number239879
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: