Provider Demographics
NPI:1962154070
Name:BALDWIN, RONALD EUGENE
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E RAY FINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5198
Mailing Address - Country:US
Mailing Address - Phone:479-806-0734
Mailing Address - Fax:918-427-3375
Practice Address - Street 1:117 E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5198
Practice Address - Country:US
Practice Address - Phone:479-806-0734
Practice Address - Fax:918-427-3375
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200879420FMedicaid
OK200879420Medicaid