Healthcare Provider Details

I. General information

NPI: 1912118928
Provider Name (Legal Business Name): RONALD FRANCIS BALDWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W A ST STE 101
MOSCOW ID
83843
US

IV. Provider business mailing address

2500 W A ST STE 101
MOSCOW ID
83843-6000
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2011
  • Fax:
Mailing address:
  • Phone: 208-882-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12352
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: