Healthcare Provider Details

I. General information

NPI: 1790714459
Provider Name (Legal Business Name): BALDWIN BONE & JOINT P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 DAPHNE AVE
DAPHNE AL
36526-4298
US

IV. Provider business mailing address

1505 DAPHNE AVE
DAPHNE AL
36526-4298
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-2663
  • Fax:
Mailing address:
  • Phone: 251-625-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY MCCLURG
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-625-2663