Provider Demographics
NPI:1235218397
Name:BAEZ, JOSE MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
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 1:11181 HEALTH PARK BLVD STE 1180
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5734
Mailing Address - Country:US
Mailing Address - Phone:239-777-0663
Mailing Address - Fax:239-777-1296
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 1180
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5734
Practice Address - Country:US
Practice Address - Phone:239-777-0663
Practice Address - Fax:239-777-1296
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110612207R00000X
CT041418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110009690Medicare ID - Type Unspecified
CTF37225Medicare UPIN