Provider Demographics
NPI:1487971842
Name:BALDWIN PEDIATRIX
Entity type:Organization
Organization Name:BALDWIN PEDIATRIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-853-1763
Mailing Address - Street 1:PO BOX 551269
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1269
Mailing Address - Country:US
Mailing Address - Phone:904-853-1763
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:6789 SOUTHPOINT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8206
Practice Address - Country:US
Practice Address - Phone:904-853-1763
Practice Address - Fax:850-248-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL127652200Medicaid