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General NPI Number Information
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NPI Number | 1861994923
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Entity Type | Individual
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Provider Name | JORGE IBRAHIM BAGHDAN ARNP
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Gender | Male
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 2896 POMEROL DR APT 403
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City | WELLINGTON
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State | FL
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Zip | 33414-9412
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Country | US
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Telephone | 561-475-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 2896 POMEROL DR APT 403
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City | WELLINGTON
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State | FL
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Zip | 33414-9412
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Country | US
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Telephone | 561-475-8368
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ARNP9245621
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License Number State | FL
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