Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 36943 | MN |
NPI | 1104853092 |
---|---|
Provider Name | Douglas Rawling Baldwin |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36943 | LICENSE (01) | MN |