Healthcare Provider Details

I. General information

NPI: 1720073596
Provider Name (Legal Business Name): BYRON DAVID BALDRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DR # 201B
HELENA MT
59601-8022
US

IV. Provider business mailing address

7300 RANCH ROAD 2222 BUILDING 1, STE 200
AUSTIN TX
78730
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-7200
  • Fax: 406-443-7201
Mailing address:
  • Phone: 512-628-0465
  • Fax: 512-628-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4902
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number4902
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number4902
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: