Healthcare Provider Details

I. General information

NPI: 1598711244
Provider Name (Legal Business Name): TONIA M BALDWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N 16TH ST
CLARINDA IA
51632-1174
US

IV. Provider business mailing address

2000 N 16TH ST
CLARINDA IA
51632-1174
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-5634
  • Fax: 712-542-6112
Mailing address:
  • Phone: 712-542-5634
  • Fax: 712-542-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34637
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: