Healthcare Provider Details

I. General information

NPI: 1336352194
Provider Name (Legal Business Name): DAVID V. BALDWIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 WILLAMETTE
EUGENE OR
97405
US

IV. Provider business mailing address

PO BOX 11143
EUGENE OR
97440-3343
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2598
  • Fax:
Mailing address:
  • Phone: 541-686-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0815
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0815
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0815
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierJ910501
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPSA
# 2
Identifier08329000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBCBS-OR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: