MEDICARE: DR. WASHINGTON DARIO BAQUERO MD

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	207Q00000X	Family Medicine Physician	0034296F	FL
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	ME34296	FL

General Provider Information

NPI Number	:	1962509521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WASHINGTON DARIO BAQUERO MD

Provider Business Mailing Address
First Line	:	1705 COLONIAL BLVD STE C1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1197
Country	:	US
Telephone Number	:	239-275-4141
Fax Number	:	239-275-4879

Provider Business Practice Location Address
First Line	:	1705 COLONIAL BLVD STE C1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1197
Country	:	US
Telephone Number	:	239-275-4141
Fax Number	:	239-275-4879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	03/17/2018

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