Healthcare Provider Details

I. General information

NPI: 1265404776
Provider Name (Legal Business Name): GARY BALDWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 E COLUMBIA AVE
COLVILLE WA
99114-3316
US

IV. Provider business mailing address

910 N WASHINGTON ST STE 209
SPOKANE WA
99201-2202
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-0824
  • Fax:
Mailing address:
  • Phone: 509-232-1145
  • Fax: 509-232-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number016261
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: