Healthcare Provider Details

I. General information

NPI: 1194828210
Provider Name (Legal Business Name): GREGORY WARREN BALDWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 GEORGIA STREET SUITE B
VALLEJO CA
94590
US

IV. Provider business mailing address

1601 FRUITVALE AVE
OAKLAND CA
94601
US

V. Phone/Fax

Practice location:
  • Phone: 707-556-8100
  • Fax: 707-556-8107
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG21457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: