Healthcare Provider Details

I. General information

NPI: 1407106230
Provider Name (Legal Business Name): NEWTON EDDIE BALDWIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PASEO DE PERALTA
SANTA FE NM
87501
US

IV. Provider business mailing address

707 PASEO DE PERALTA
SANTA FE NM
87501
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8707
  • Fax: 505-989-3536
Mailing address:
  • Phone: 505-989-8707
  • Fax: 505-989-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2012-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: