Healthcare Provider Details

I. General information

NPI: 1194429639
Provider Name (Legal Business Name): EUGENE BALDWIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 FORESTDALE BLVD
BIRMINGHAM AL
35214-2042
US

IV. Provider business mailing address

1664 FORESTDALE BLVD
BIRMINGHAM AL
35214-2042
US

V. Phone/Fax

Practice location:
  • Phone: 205-409-2794
  • Fax:
Mailing address:
  • Phone: 205-409-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-182756
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-182756
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: