MEDICARE: DR. HENRY JACKSON BASKIN SR. 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME21614	FL

General Provider Information

NPI Number	:	1871598128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY JACKSON BASKIN SR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3659
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-3659
Country	:	US
Telephone Number	:	407-628-2521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 N ORANGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4627
Country	:	US
Telephone Number	:	407-896-2410
Fax Number	:	407-898-7106

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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