=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306392436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE M. BAEZ, MD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2016
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD STE 1180
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-777-0663
-----------------------------------------------------
Fax | 239-777-1296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD SUITE 1180
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-777-0663
-----------------------------------------------------
Fax | 239-777-1296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. JOSE MIGUEL BAEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-777-0663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME110612
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------