Individual
MR. JONATHAN E BALDWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(563) 742-2054
(563) 742-3505
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(563) 742-2054
(563) 742-3505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001737
IA
363AM0700X
Medical Physician Assistant
Primary
85002801
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32117
BC WELLMARK
—
01
—
98263
BC WELLMARK
—
01
—
98269
BC WELLMARK
—
01
—
P00404317
RR MEDICARE
IL
Enumeration date
10/18/2006
Last updated
04/19/2018
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