Healthcare Provider Details

I. General information

NPI: 1396805461
Provider Name (Legal Business Name): NORTH BALDWIN PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 MEDICAL CENTER DR
BAY MINETTE AL
36507-4163
US

IV. Provider business mailing address

2004 MEDICAL CENTER DR
BAY MINETTE AL
36507-4163
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-8475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY PALAZZO
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 251-435-1361