Provider Demographics
NPI:1255303509
Name:BAEZ, MARIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:M
Last Name:BAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2240 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6332
Mailing Address - Country:US
Mailing Address - Phone:561-736-3221
Mailing Address - Fax:561-736-5656
Practice Address - Street 1:2240 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6332
Practice Address - Country:US
Practice Address - Phone:561-736-3221
Practice Address - Fax:561-736-5656
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27948Medicare ID - Type Unspecified
FLG19930Medicare UPIN