Basic Information
| Provider Information | |||||||||
| NPI: | 1295728897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDRIDGE | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 E 17TH N | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836471759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085870155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 365 MCKENNA DR | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085879703 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | O-333 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS1201X | 009868 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine |
No ID Information.