Healthcare Provider Details

I. General information

NPI: 1831131820
Provider Name (Legal Business Name): ROBERT JAMES BALDREE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/29/2023
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 QUAKER AVE
LUBBOCK TX
79424-3367
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-3306
  • Fax: 806-722-3861
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-782-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04652
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberPA04652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: