Provider Demographics
NPI:1699075705
Name:BALDWIN INFECTIOUS DISEASE SPECIALIST LLC
Entity type:Organization
Organization Name:BALDWIN INFECTIOUS DISEASE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-404-7344
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:POINT CLEAR
Mailing Address - State:AL
Mailing Address - Zip Code:36564-1750
Mailing Address - Country:US
Mailing Address - Phone:251-990-1980
Mailing Address - Fax:251-990-1988
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-990-1980
Practice Address - Fax:251-990-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20933207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDR4105OtherRR MEDICARE
AL124084Medicaid
AL102G707310Medicare PIN