Basic Information
| Provider Information | |||||||||
| NPI: | 1104820554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 MADISON OAK DRIVE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104813006 | ||||||||
| FaxNumber: | 2104813793 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 MADISON OAK DRIVE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104813006 | ||||||||
| FaxNumber: | 2104813793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 11/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 7025 | AL | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | M3884 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4041476 | 05 | TN | MEDICAID | 096153100 | 05 | FL | MEDICAID | 1710246 | 01 | AL | UNITED HEALTHCARE | OTHER | 183103401 | 05 | TX | MEDICAID | 051009542 | 01 | AL | BLUE CROSS | OTHER | 51009542BAL | 01 | AL | VIVA HEALTH | OTHER | 000009542 | 05 | AL | MEDICAID |