Basic Information
| Provider Information | |||||||||
| NPI: | 1255384988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8803 S 101ST EAST AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741335726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182502033 | ||||||||
| FaxNumber: | 9183924465 | ||||||||
| Practice Location | |||||||||
| Address1: | 8803 S 101ST EAST AVE | ||||||||
| Address2: | SUITE 385 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741335726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182502033 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 21802 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100102610B | 05 | OK | MEDICAID | 800522535 | 01 | OK | MEDICARE GROUP PIN | OTHER |