Healthcare Provider Details

I. General information

NPI: 1083064844
Provider Name (Legal Business Name): ABDULRAHMAN BAQAIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MILITARY TRL
JUPITER FL
33458-4834
US

IV. Provider business mailing address

1301 3RD ST STE 200
WICHITA FALLS TX
76301-2245
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-4800
  • Fax:
Mailing address:
  • Phone: 940-767-5145
  • Fax: 940-767-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME147716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: