Provider Demographics
NPI:1104820554
Name:BALDWIN, CHARLES EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EUGENE
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 MADISON OAK DRIVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4298
Mailing Address - Country:US
Mailing Address - Phone:210-481-3006
Mailing Address - Fax:210-481-3793
Practice Address - Street 1:502 MADISON OAK DRIVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4298
Practice Address - Country:US
Practice Address - Phone:210-481-3006
Practice Address - Fax:210-481-3793
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL70252086S0120X
TXM38842086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4041476Medicaid
FL096153100Medicaid
AL1710246OtherUNITED HEALTHCARE
TX183103401Medicaid
AL051009542OtherBLUE CROSS
AL51009542BALOtherVIVA HEALTH
AL000009542Medicaid
TN4041476Medicaid