Provider Demographics
NPI:1154443661
Name:BAEZ, JOSE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:W
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2061
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2061
Mailing Address - Country:US
Mailing Address - Phone:787-834-8641
Mailing Address - Fax:787-265-4100
Practice Address - Street 1:55 CALLE MEDITACION
Practice Address - Street 2:6-A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4882
Practice Address - Country:US
Practice Address - Phone:787-834-8641
Practice Address - Fax:787-265-4100
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6536207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-26742Medicare UPIN