Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD2013-0772 | NM |
N | 208D00000X | General Practice Physician | MD2013-0772 | NM |
NPI | 1730470113 |
---|---|
Provider Name | Evan D Baldwin |
First Address | Albuquerque, NM 87181-0279 |
Second Address | Albuquerque, NM 87105-3179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 19/10/2015 |