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General NPI Number Information
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NPI Number | 1114136983
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Entity Type | Organization
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Legal Business Name | BYRON DAVID BALDRIDGE
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2300 12TH AVE S SUITE 101
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City | GREAT FALLS
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State | MT
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Zip | 59405-5017
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Country | US
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Telephone | 406-727-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 12TH AVE S SUITE 101
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City | GREAT FALLS
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State | MT
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Zip | 59405-5017
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Country | US
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Telephone | 406-727-1131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BYRON DAVID BALDRIDGE
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Credential | M.D.
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Telephone | 406-727-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4902
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License Number State | MT
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