Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 61518 | MN |
NPI | 1316212632 |
---|---|
Provider Name | Dr. Brett James Baldwin |
First Address | Mankato, MN 56002-8674 |
Second Address | Mankato, MN 56001-6076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 31/07/2020 |