Provider Demographics
NPI:1306392436
Name:JOSE M. BAEZ, MD, LLC
Entity type:Organization
Organization Name:JOSE M. BAEZ, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-777-0663
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 1180
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5738
Mailing Address - Country:US
Mailing Address - Phone:239-777-0663
Mailing Address - Fax:239-777-1296
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 1180
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5734
Practice Address - Country:US
Practice Address - Phone:239-777-0663
Practice Address - Fax:239-777-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235218397OtherINDIVIDUAL NPI