Provider Demographics
NPI:1720151947
Name:BAIZE, JAMES R JR (DMIN)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:BAIZE
Suffix:JR
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 HAHNS LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-8514
Mailing Address - Country:US
Mailing Address - Phone:812-985-2716
Mailing Address - Fax:
Practice Address - Street 1:909B S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7514
Practice Address - Country:US
Practice Address - Phone:812-402-9292
Practice Address - Fax:812-402-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002310A1041C0700X
IN35000009A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist