Healthcare Provider Details

I. General information

NPI: 1285838433
Provider Name (Legal Business Name): PETER ANDREW BALDWIN MD, MBA, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544
US

IV. Provider business mailing address

113 LIELMANIS AVE
HURLBURT FIELD FL
32544-5613
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-3307
  • Fax:
Mailing address:
  • Phone: 850-881-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065926A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01065926A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301090292
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01065926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: