Healthcare Provider Details

I. General information

NPI: 1124161542
Provider Name (Legal Business Name): WASHINGTON D. BAQUERO, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 COLONIAL BLVD STE C-1
FORT MYERS FL
33907-1195
US

IV. Provider business mailing address

1705 COLONIAL BLVD STE C-1
FORT MYERS FL
33907-1195
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-4141
  • Fax: 239-275-4879
Mailing address:
  • Phone: 239-275-4141
  • Fax: 239-275-4879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASHINGTON D. BAQUERO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 239-275-4141