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General NPI Number Information
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NPI Number | 1669875670
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Entity Type | Individual
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Provider Name | ESDRA JEAN BAPTISTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 4435 US HIGHWAY 98 N SUIT B
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City | LAKELAND
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State | FL
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Zip | 33809-0402
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Country | US
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Telephone | 863-858-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 5040 LONG LAKE CIR 304
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City | LAKELAND
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State | FL
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Zip | 33805-9581
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Country | US
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Telephone | 410-845-9295
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Fax | 863-582-9265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 18853
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License Number State | PR
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