MEDICARE: JOSE F BACA MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME57517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073817052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE F BACA MD INC

Provider Business Mailing Address
First Line	:	777 E 25TH ST STE 509
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3834
Country	:	US
Telephone Number	:	305-696-7557
Fax Number	:	305-696-7469

Provider Business Practice Location Address
First Line	:	777 E 25TH ST STE 509
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3834
Country	:	US
Telephone Number	:	305-696-7557
Fax Number	:	305-696-7469

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JOSE F BACA
Credential	:	M.D.
Telephone Number	:	305-696-7557

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/05/2011

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