MEDICARE: DR. MARIO M BAEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME68977	FL

General Provider Information

NPI Number	:	1255303509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO M BAEZ M.D.

Provider Business Mailing Address
First Line	:	2240 W WOOLBRIGHT RD
Second Line	:	SUITE 305
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6332
Country	:	US
Telephone Number	:	561-736-3221
Fax Number	:	561-736-5656

Provider Business Practice Location Address
First Line	:	2240 W WOOLBRIGHT RD
Second Line	:	SUITE 305
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6332
Country	:	US
Telephone Number	:	561-736-3221
Fax Number	:	561-736-5656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/04/2010

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